- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,340.10 / $5,063.00 / $9,488.00
| Facility | | $1,340.10 | $5,063.00 | $9,488.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,196.42 / $1,463.65 / $3,483.62
| Professional | | $1,196.42 | $1,463.65 | $3,483.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,226.13 / $6,105.48 / $13,137.87
| Facility | | $2,226.13 | $6,105.48 | $13,137.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,216.24 / $1,715.02 / $3,130.99
| Professional | | $1,216.24 | $1,715.02 | $3,130.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $550.00 / $550.00 / $550.00
| Facility | | $550.00 | $550.00 | $550.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,374.67 / $1,997.57 / $3,302.29
| Professional | | $1,374.67 | $1,997.57 | $3,302.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,206.46 / $1,568.40 / $2,536.08
| Professional | | $1,206.46 | $1,568.40 | $2,536.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $607.00 / $3,629.00 / $10,000.00
| Facility | | $607.00 | $3,629.00 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,283.77 / $1,805.27 / $3,017.17
| Professional | | $1,283.77 | $1,805.27 | $3,017.17 |