- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,778.28 / $8,709.64
| Facility | | $1,071.52 | $1,778.28 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,258.93 / $2,951.21
| Professional | | $1,071.52 | $1,258.93 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,621.81 / $2,884.03
| Professional | | $1,348.96 | $1,621.81 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,659.59 / $2,818.38
| Professional | | $1,202.26 | $1,659.59 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,513.56 / $2,454.71
| Facility | | $1,071.52 | $1,513.56 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $2,041.74 / $2,691.53
| Professional | | $7.08 | $2,041.74 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $3,890.45 / $6,918.31
| Facility | | $1,174.90 | $3,890.45 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,348.96 / $2,511.89
| Professional | | $1,047.13 | $1,348.96 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $10,000.00 / $10,000.00
| Facility | | $56.23 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,511.38 / $8,511.38 / $9,120.11
| Professional | | $8,511.38 | $8,511.38 | $9,120.11 |