- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $5,888.44 / $15,135.61
| Facility | | $2,041.74 | $5,888.44 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,041.74 / $2,511.89
| Professional | | $1,513.56 | $2,041.74 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $14,791.08 / $15,848.93
| Facility | | $11,748.98 | $14,791.08 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,288.25 / $1,862.09
| Professional | | $1,000.00 | $1,288.25 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $912.01 / $1,258.93
| Professional | | $741.31 | $912.01 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,413.10 / $8,912.51 / $10,964.78
| Professional | | $7,413.10 | $8,912.51 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,995.26 / $7,079.46
| Facility | | $1,380.38 | $1,995.26 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,235.94 / $10,000.00
| Facility | | $1,584.89 | $3,235.94 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,235.94 / $10,000.00
| Professional | | $1,584.89 | $3,235.94 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,467.37 / $7,079.46
| Facility | | $1,698.24 | $3,467.37 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,548.82 / $3,090.30
| Professional | | $954.99 | $1,548.82 | $3,090.30 |