- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $4,897.79 / $8,511.38
| Facility | | $1,380.38 | $4,897.79 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,412.54 / $2,344.23
| Professional | | $1,071.52 | $1,412.54 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,786.30 / $10,000.00
| Facility | | $2,238.72 | $4,786.30 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,445.44 / $2,398.83
| Professional | | $1,202.26 | $1,445.44 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,202.26 / $1,905.46
| Professional | | $1,096.48 | $1,202.26 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $1,659.59 / $2,630.27
| Professional | | $512.86 | $1,659.59 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $2,187.76 / $9,772.37
| Facility | | $54.95 | $2,187.76 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,819.70 / $10,232.93
| Professional | | $1,148.15 | $1,819.70 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,818.38 / $10,471.29
| Facility | | $1,288.25 | $2,818.38 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,479.11 / $2,951.21
| Professional | | $1,148.15 | $1,479.11 | $2,951.21 |