- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,000.00 / $45,708.82
| Facility | | $6,606.93 | $10,000.00 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $5,888.44 / $7,079.46
| Professional | | $2,691.53 | $5,888.44 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $16,595.87 / $34,673.69
| Facility | | $8,709.64 | $16,595.87 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,943.28 / $10,232.93 / $16,595.87
| Professional | | $7,943.28 | $10,232.93 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $11,481.54 / $29,512.09
| Facility | | $134.90 | $11,481.54 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,025.60 / $7,244.36 / $7,762.47
| Professional | | $6,025.60 | $7,244.36 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $7,585.78 / $15,488.17
| Facility | | $3,548.13 | $7,585.78 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $4,570.88 / $7,943.28
| Professional | | $3,019.95 | $4,570.88 | $7,943.28 |