- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,365.16 / $14,791.08
| Facility | | $2,344.23 | $4,365.16 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,187.76 / $2,951.21
| Professional | | $1,096.48 | $2,187.76 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $12,302.69 / $17,782.79
| Facility | | $9,772.37 | $12,302.69 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,818.38 / $4,073.80
| Professional | | $2,238.72 | $2,818.38 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,630.78 / $4,897.79
| Professional | | $2,884.03 | $3,630.78 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,630.27 / $4,570.88
| Professional | | $1,862.09 | $2,630.27 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,949.84 / $2,398.83
| Professional | | $1,621.81 | $1,949.84 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,344.23 / $4,168.69
| Facility | | $1,862.09 | $2,344.23 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,570.40 / $10,000.00
| Facility | | $1,621.81 | $2,570.40 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,570.40 / $10,000.00
| Professional | | $1,621.81 | $2,570.40 | $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
- $1,412.54 / $2,290.87 / $3,388.44
| Professional | | $1,412.54 | $2,290.87 | $3,388.44 |