- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,071.52 / $5,011.87
| Facility | | $1,071.52 | $1,071.52 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,258.93 / $1,995.26
| Professional | | $1,071.52 | $1,258.93 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $11,748.98 / $25,118.86
| Facility | | $6,456.54 | $11,748.98 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,630.27 / $4,265.80
| Professional | | $1,778.28 | $2,630.27 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,168.69 / $10,000.00
| Facility | | $2,951.21 | $4,168.69 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,548.13 / $5,370.32
| Professional | | $2,344.23 | $3,548.13 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,981.07 / $7,943.28
| Facility | | $3,235.94 | $3,981.07 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,019.95 / $4,570.88
| Professional | | $2,137.96 | $3,019.95 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,290.87 / $8,317.64
| Facility | | $1,412.54 | $2,290.87 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,454.71 / $6,456.54
| Professional | | $1,479.11 | $2,454.71 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $5,248.07 / $12,589.25
| Facility | | $3,235.94 | $5,248.07 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,398.83 / $4,677.35
| Professional | | $1,348.96 | $2,398.83 | $4,677.35 |