- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,073.80 / $12,022.64
| Facility | | $1,862.09 | $4,073.80 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,905.46 / $6,606.93
| Professional | | $1,202.26 | $1,905.46 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $1,412.54 / $1,412.54
| Facility | | $446.68 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $2,137.96 / $2,238.72
| Professional | | $512.86 | $2,137.96 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,548.82 / $5,754.40
| Professional | | $1,230.27 | $1,548.82 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $4,073.80 / $5,754.40
| Facility | | $1,778.28 | $4,073.80 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,778.28 / $3,630.78
| Professional | | $1,288.25 | $1,778.28 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,412.54 / $5,754.40
| Professional | | $1,230.27 | $1,412.54 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,888.44 / $10,000.00
| Facility | | $2,884.03 | $5,888.44 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,659.59 / $2,187.76
| Professional | | $1,380.38 | $1,659.59 | $2,187.76 |