- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $7,585.78 / $15,135.61
| Facility | | $1,659.59 | $7,585.78 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,168.69 / $7,943.28
| Professional | | $3,388.44 | $4,168.69 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $6,309.57 / $10,000.00
| Professional | | $4,365.16 | $6,309.57 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $575.44 / $35,481.34
| Facility | | $489.78 | $575.44 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $5,754.40 / $9,549.93
| Professional | | $3,548.13 | $5,754.40 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,265.80 / $7,244.36
| Facility | | $3,388.44 | $4,265.80 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $3,388.44 / $3,388.44
| Professional | | $3,388.44 | $3,388.44 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.14 / $6,918.31 / $7,413.10
| Professional | | $15.14 | $6,918.31 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $1,819.70 / $6,309.57
| Facility | | $309.03 | $1,819.70 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,265.80 / $7,585.78
| Professional | | $3,235.94 | $4,265.80 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $66,069.34 / $66,069.34
| Facility | | $2,818.38 | $66,069.34 | $66,069.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26,302.68 / $26,302.68 / $31,622.78
| Professional | | $26,302.68 | $26,302.68 | $31,622.78 |