- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $10,000.00 / $16,982.44
| Facility | | $2,344.23 | $10,000.00 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,318.26 / $3,162.28
| Professional | | $954.99 | $1,318.26 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,467.37 / $4,570.88
| Professional | | $2,570.40 | $3,467.37 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,659.59 / $7,244.36
| Facility | | $933.25 | $1,659.59 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,630.78 / $5,370.32
| Professional | | $2,454.71 | $3,630.78 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,365.16 / $6,165.95
| Professional | | $3,388.44 | $4,365.16 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,621.81 / $5,623.41
| Facility | | $977.24 | $1,621.81 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $1,445.44 / $3,467.37
| Professional | | $60.26 | $1,445.44 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $4,786.30 / $6,165.95
| Professional | | $1,174.90 | $4,786.30 | $6,165.95 |