- 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
- $812.83 / $1,096.48 / $2,630.27
| Professional | | $812.83 | $1,096.48 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,884.03 / $3,715.35
| Professional | | $2,137.96 | $2,884.03 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,737.80 / $6,025.60
| Facility | | $776.25 | $1,737.80 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,951.21 / $4,466.84
| Professional | | $1,995.26 | $2,951.21 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,630.78 / $5,011.87
| Professional | | $2,818.38 | $3,630.78 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,621.81 / $4,677.35
| Facility | | $812.83 | $1,621.81 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $1,202.26 / $2,884.03
| Professional | | $60.26 | $1,202.26 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $3,981.07 / $5,128.61
| Professional | | $977.24 | $3,981.07 | $5,128.61 |