- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $4,265.80 / $10,000.00
| Facility | | $3,090.30 | $4,265.80 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,238.72 / $2,630.27
| Professional | | $1,479.11 | $2,238.72 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $2,691.53 / $8,128.31
| Facility | | $2,691.53 | $2,691.53 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $33.11 / $69.18
| Professional | | $28.18 | $33.11 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $39,810.72 / $58,884.37
| Facility | | $2,630.27 | $39,810.72 | $58,884.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $1,778.28 / $10,471.29
| Facility | | $1,778.28 | $1,778.28 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $3,311.31 / $8,128.31
| Professional | | $43.65 | $3,311.31 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $2,691.53 / $2,691.53
| Facility | | $2,691.53 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,621.81 / $2,691.53
| Professional | | $1,148.15 | $1,621.81 | $2,691.53 |