- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,488.17 / $28,183.83 / $43,651.58
| Facility | | $15,488.17 | $28,183.83 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,388.44 / $12,022.64
| Professional | | $2,884.03 | $3,388.44 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $10,000.00 / $10,000.00
| Facility | | $10,000.00 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $3,630.78 / $25,703.96
| Facility | | $3,630.78 | $3,630.78 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,630.78 / $11,481.54
| Professional | | $3,235.94 | $3,630.78 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $13,182.57 / $14,454.40
| Facility | | $3,630.78 | $13,182.57 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,128.31 / $8,128.31 / $8,128.31
| Professional | | $8,128.31 | $8,128.31 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $10,000.00 / $17,378.01
| Facility | | $2,884.03 | $10,000.00 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $60.26 / $3,235.94
| Professional | | $60.26 | $60.26 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $7,244.36 / $10,964.78
| Professional | | $2,137.96 | $7,244.36 | $10,964.78 |