- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $4,897.79 / $8,511.38
| Facility | | $1,698.24 | $4,897.79 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,698.24 / $2,398.83
| Professional | | $1,318.26 | $1,698.24 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,677.35 / $10,000.00
| Facility | | $2,238.72 | $4,677.35 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,819.70 / $2,951.21
| Professional | | $1,513.56 | $1,819.70 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,513.56 / $2,238.72
| Professional | | $1,288.25 | $1,513.56 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,041.74 / $3,801.89
| Professional | | $1,174.90 | $2,041.74 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $2,454.71 / $11,748.98
| Facility | | $54.95 | $2,454.71 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,344.23 / $16,595.87
| Professional | | $1,348.96 | $2,344.23 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,818.38 / $10,471.29
| Facility | | $1,348.96 | $2,818.38 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,137.96 / $3,630.78
| Professional | | $1,348.96 | $2,137.96 | $3,630.78 |