- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $4,897.79 / $8,511.38
| Facility | | $1,778.28 | $4,897.79 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,445.44 / $3,019.95
| Professional | | $1,071.52 | $1,445.44 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $5,128.61 / $10,000.00
| Facility | | $2,238.72 | $5,128.61 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,584.89 / $2,344.23
| Professional | | $1,288.25 | $1,584.89 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,258.93 / $1,995.26
| Professional | | $1,096.48 | $1,258.93 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $1,737.80 / $2,630.27
| Professional | | $512.86 | $1,737.80 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $2,137.96 / $10,964.78
| Facility | | $54.95 | $2,137.96 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,778.28 / $9,120.11
| Professional | | $1,202.26 | $1,778.28 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,715.35 / $9,120.11
| Facility | | $2,454.71 | $3,715.35 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,479.11 / $2,398.83
| Professional | | $1,202.26 | $1,479.11 | $2,398.83 |