- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,897.79 / $10,471.29
| Facility | | $2,884.03 | $4,897.79 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,659.59 / $3,019.95
| Professional | | $1,445.44 | $1,659.59 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $16,218.10 / $18,620.87
| Facility | | $8,709.64 | $16,218.10 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,090.30 / $3,981.07
| Professional | | $1,445.44 | $3,090.30 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,691.53 / $4,677.35
| Professional | | $1,445.44 | $2,691.53 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,454.71 / $2,951.21
| Professional | | $1,862.09 | $2,454.71 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $4,786.30 / $10,000.00
| Facility | | $758.58 | $4,786.30 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,041.74 / $4,466.84
| Professional | | $1,380.38 | $2,041.74 | $4,466.84 |