- 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
- $1,023.29 / $1,412.54 / $3,311.31
| Professional | | $1,023.29 | $1,412.54 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,630.78 / $4,786.30
| Professional | | $2,754.23 | $3,630.78 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,737.80 / $7,585.78
| Facility | | $977.24 | $1,737.80 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,801.89 / $5,623.41
| Professional | | $2,570.40 | $3,801.89 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $4,570.88 / $6,456.54
| Professional | | $3,548.13 | $4,570.88 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,698.24 / $6,025.60
| Facility | | $1,023.29 | $1,698.24 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $1,513.56 / $3,630.78
| Professional | | $60.26 | $1,513.56 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $5,011.87 / $6,456.54
| Professional | | $1,230.27 | $5,011.87 | $6,456.54 |