- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $831.76 / $2,630.27
| Facility | | $831.76 | $831.76 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $977.24 / $1,659.59
| Professional | | $831.76 | $977.24 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $12,589.25 / $36,307.81
| Facility | | $7,762.47 | $12,589.25 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,949.84 / $3,162.28
| Professional | | $1,318.26 | $1,949.84 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,162.28 / $7,413.10
| Facility | | $2,238.72 | $3,162.28 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,691.53 / $4,073.80
| Professional | | $1,778.28 | $2,691.53 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,019.95 / $5,888.44
| Facility | | $2,398.83 | $3,019.95 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,238.72 / $3,388.44
| Professional | | $1,621.81 | $2,238.72 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,778.28 / $10,000.00
| Facility | | $1,122.02 | $1,778.28 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,778.28 / $3,801.89
| Professional | | $1,047.13 | $1,778.28 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $6,456.54 / $13,489.63
| Facility | | $3,311.31 | $6,456.54 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,778.28 / $3,388.44
| Professional | | $1,047.13 | $1,778.28 | $3,388.44 |