- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,100.00 / $3,035.21 / $19,805.75
| Facility | | $2,100.00 | $3,035.21 | $19,805.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,206.01 / $3,514.57 / $6,339.18
| Facility | | $1,206.01 | $3,514.57 | $6,339.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,664.76 / $3,586.81 / $3,971.12
| Facility | | $2,664.76 | $3,586.81 | $3,971.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,250.00 / $2,587.50 / $3,898.10
| Professional | | $2,250.00 | $2,587.50 | $3,898.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $373.07 / $585.88 / $1,750.00
| Facility | | $373.07 | $585.88 | $1,750.00 |
- 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 |