- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $4,677.35 / $7,413.10
| Facility | | $1,778.28 | $4,677.35 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,630.27 / $3,981.07
| Professional | | $1,778.28 | $2,630.27 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $18,197.01 / $21,877.62
| Facility | | $14,125.38 | $18,197.01 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $239.88 / $416.87
| Professional | | $239.88 | $239.88 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,311.31 / $3,630.78
| Professional | | $3,090.30 | $3,311.31 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $8,709.64 / $17,782.79
| Facility | | $3,548.13 | $8,709.64 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $4,265.80 / $5,128.61
| Professional | | $4,265.80 | $4,265.80 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,890.45 / $4,897.79
| Professional | | $3,467.37 | $3,890.45 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,162.28 / $4,786.30
| Facility | | $1,905.46 | $3,162.28 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $7,413.10
| Professional | | $2,290.87 | $2,290.87 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $4,073.80 / $10,000.00
| Facility | | $2,454.71 | $4,073.80 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $4,073.80 / $10,000.00
| Professional | | $2,454.71 | $4,073.80 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,467.37 / $4,168.69
| Facility | | $2,089.30 | $3,467.37 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,737.80 / $3,981.07
| Professional | | $1,479.11 | $1,737.80 | $3,981.07 |