- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $7,244.36 / $10,000.00
| Facility | | $2,290.87 | $7,244.36 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,570.40 / $3,090.30
| Professional | | $2,137.96 | $2,570.40 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $7,943.28 / $15,488.17
| Facility | | $3,548.13 | $7,943.28 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,235.94 / $12,302.69
| Professional | | $1,949.84 | $3,235.94 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,089.30 / $3,019.95
| Facility | | $1,659.59 | $2,089.30 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,511.89 / $5,248.07
| Facility | | $2,290.87 | $2,511.89 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,981.07 / $3,981.07 / $4,677.35
| Professional | | $3,981.07 | $3,981.07 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $4,677.35 / $5,495.41
| Professional | | $4,677.35 | $4,677.35 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $5,248.07
| Professional | | $3,235.94 | $3,235.94 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $7,943.28 / $15,488.17
| Facility | | $3,548.13 | $7,943.28 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,235.94 / $12,302.69
| Professional | | $1,949.84 | $3,235.94 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,235.94 / $3,890.45
| Facility | | $1,949.84 | $3,235.94 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,511.89 / $5,623.41
| Professional | | $1,949.84 | $2,511.89 | $5,623.41 |