- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $4,365.16 / $11,481.54
| Facility | | $2,398.83 | $4,365.16 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,318.26 / $2,570.40
| Professional | | $1,148.15 | $1,318.26 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $25,703.96 / $38,904.51
| Facility | | $15,135.61 | $25,703.96 | $38,904.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,511.89 / $3,715.35
| Professional | | $1,202.26 | $2,511.89 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,905.46 / $3,388.44
| Professional | | $1,000.00 | $1,905.46 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $4,466.84 / $10,000.00
| Facility | | $851.14 | $4,466.84 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,995.26 / $3,162.28
| Professional | | $1,348.96 | $1,995.26 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $4,466.84 / $10,000.00
| Facility | | $851.14 | $4,466.84 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,949.84 / $3,467.37
| Professional | | $1,318.26 | $1,949.84 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,348.96 / $1,584.89
| Facility | | $933.25 | $1,348.96 | $1,584.89 |