- 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
- $794.33 / $1,096.48 / $2,570.40
| Professional | | $794.33 | $1,096.48 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,818.38 / $3,715.35
| Professional | | $2,137.96 | $2,818.38 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,380.38 / $5,888.44
| Facility | | $776.25 | $1,380.38 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,951.21 / $4,466.84
| Professional | | $2,041.74 | $2,951.21 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,630.78 / $5,011.87
| Professional | | $2,754.23 | $3,630.78 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,348.96 / $4,677.35
| Facility | | $812.83 | $1,348.96 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $1,174.90 / $2,818.38
| Professional | | $60.26 | $1,174.90 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $3,890.45 / $5,011.87
| Professional | | $977.24 | $3,890.45 | $5,011.87 |