- 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
- $1,000.00 / $1,380.38 / $3,235.94
| Professional | | $1,000.00 | $1,380.38 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,630.78 / $4,677.35
| Professional | | $2,691.53 | $3,630.78 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,659.59 / $7,585.78
| Facility | | $977.24 | $1,659.59 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,715.35 / $5,623.41
| Professional | | $2,570.40 | $3,715.35 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $4,570.88 / $6,456.54
| Professional | | $3,467.37 | $4,570.88 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,621.81 / $5,888.44
| Facility | | $1,023.29 | $1,621.81 | $5,888.44 |
- 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 |