- 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
- $741.31 / $1,047.13 / $2,454.71
| Professional | | $741.31 | $1,047.13 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,630.27 / $3,801.89
| Professional | | $2,089.30 | $2,630.27 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,348.96 / $5,754.40
| Facility | | $794.33 | $1,348.96 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,951.21 / $4,570.88
| Professional | | $2,089.30 | $2,951.21 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,548.13 / $4,786.30
| Professional | | $2,630.27 | $3,548.13 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,318.26 / $4,570.88
| Facility | | $812.83 | $1,318.26 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $1,096.48 / $2,630.27
| Professional | | $60.26 | $1,096.48 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,467.37 / $4,677.35
| Professional | | $1,023.29 | $3,467.37 | $4,677.35 |