- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $5,754.40 / $11,481.54
| Facility | | $1,445.44 | $5,754.40 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,715.35 / $4,073.80
| Professional | | $2,398.83 | $3,715.35 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,025.60 / $6,025.60 / $6,025.60
| Professional | | $6,025.60 | $6,025.60 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $9,332.54 / $10,471.29
| Facility | | $457.09 | $9,332.54 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,378.01 / $17,378.01 / $17,378.01
| Professional | | $17,378.01 | $17,378.01 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $3,981.07 / $7,413.10
| Facility | | $2,951.21 | $3,981.07 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $912.01 / $1,000.00
| Professional | | $870.96 | $912.01 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $50.12 / $1,737.80
| Professional | | $50.12 | $50.12 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $19,952.62 / $28,183.83
| Facility | | $10,000.00 | $19,952.62 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,630.78 / $5,754.40
| Professional | | $3,162.28 | $3,630.78 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,412.54 / $3,235.94
| Professional | | $1,412.54 | $1,412.54 | $3,235.94 |