- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,981.07 / $10,000.00
| Facility | | $1,230.27 | $3,981.07 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,258.93 / $1,479.11
| Professional | | $870.96 | $1,258.93 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $8,317.64 / $16,982.44
| Facility | | $3,981.07 | $8,317.64 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.15 / $56.23 / $128.82
| Professional | | $37.15 | $56.23 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $7,762.47
| Facility | | $2,238.72 | $2,238.72 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,888.44 / $5,888.44 / $5,888.44
| Professional | | $5,888.44 | $5,888.44 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $4,265.80 / $9,772.37
| Facility | | $1,479.11 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,778.28 / $3,162.28
| Professional | | $1,202.26 | $1,778.28 | $3,162.28 |