- 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
- $2,630.27 / $4,265.80 / $10,000.00
| Professional | | $2,630.27 | $4,265.80 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,317.64 / $11,220.18 / $14,454.40
| Professional | | $8,317.64 | $11,220.18 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $5,370.32 / $23,442.29
| Facility | | $2,951.21 | $5,370.32 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,762.47 / $11,481.54 / $16,982.44
| Professional | | $7,762.47 | $11,481.54 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,715.19 / $13,803.84 / $19,498.45
| Professional | | $10,715.19 | $13,803.84 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $5,011.87 / $18,197.01
| Facility | | $3,162.28 | $5,011.87 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $4,677.35 / $11,220.18
| Professional | | $60.26 | $4,677.35 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $13,489.63 / $19,952.62
| Professional | | $3,715.35 | $13,489.63 | $19,952.62 |