- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $10,000.00 / $20,417.38
| Facility | | $2,344.23 | $10,000.00 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,137.96 / $5,011.87
| Professional | | $1,548.82 | $2,137.96 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,168.69 / $5,623.41 / $7,244.36
| Professional | | $4,168.69 | $5,623.41 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,691.53 / $11,748.98
| Facility | | $1,479.11 | $2,691.53 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $5,011.87 / $8,511.38
| Professional | | $3,801.89 | $5,011.87 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,495.41 / $6,918.31 / $10,000.00
| Professional | | $5,495.41 | $6,918.31 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,630.27 / $9,120.11
| Facility | | $1,584.89 | $2,630.27 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $2,344.23 / $5,623.41
| Professional | | $60.26 | $2,344.23 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $7,762.47 / $10,000.00
| Professional | | $1,862.09 | $7,762.47 | $10,000.00 |