- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $10,000.00 / $20,417.38
| Facility | | $1,862.09 | $10,000.00 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $812.83 / $1,862.09
| Professional | | $630.96 | $812.83 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,137.96 / $2,691.53
| Professional | | $1,584.89 | $2,137.96 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,230.27 / $4,365.16
| Facility | | $562.34 | $1,230.27 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,187.76 / $3,311.31
| Professional | | $1,479.11 | $2,187.76 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,570.40 / $3,890.45
| Professional | | $2,041.74 | $2,570.40 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,122.02 / $3,388.44
| Facility | | $575.44 | $1,122.02 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $891.25 / $2,137.96
| Professional | | $60.26 | $891.25 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $2,884.03 / $3,715.35
| Professional | | $707.95 | $2,884.03 | $3,715.35 |