- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $4,365.16 / $14,791.08
| Facility | | $2,187.76 | $4,365.16 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,862.09 / $2,290.87
| Professional | | $660.69 | $1,862.09 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $13,182.57 / $15,488.17
| Facility | | $9,772.37 | $13,182.57 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,238.72 / $3,981.07
| Professional | | $1,548.82 | $2,238.72 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $8,128.31 / $10,000.00
| Professional | | $4,466.84 | $8,128.31 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,332.54 / $9,332.54 / $9,332.54
| Professional | | $9,332.54 | $9,332.54 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,041.74 / $2,511.89
| Professional | | $1,698.24 | $2,041.74 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,862.09 / $3,235.94
| Facility | | $1,071.52 | $1,862.09 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $3,311.31 / $10,964.78
| Facility | | $1,659.59 | $3,311.31 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $3,311.31 / $10,964.78
| Professional | | $1,659.59 | $3,311.31 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $9,549.93 / $19,054.61
| Facility | | $5,623.41 | $9,549.93 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $1,737.80 / $4,677.35
| Professional | | $562.34 | $1,737.80 | $4,677.35 |