- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $10,000.00 / $18,197.01
| Facility | | $3,090.30 | $10,000.00 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,513.56 / $2,454.71
| Professional | | $1,122.02 | $1,513.56 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $9,332.54 / $17,378.01
| Facility | | $3,981.07 | $9,332.54 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,288.25 / $1,995.26
| Professional | | $1,122.02 | $1,288.25 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $3,715.35 / $4,786.30
| Facility | | $812.83 | $3,715.35 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,584.89 / $2,630.27
| Professional | | $1,071.52 | $1,584.89 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,548.82 / $2,754.23
| Facility | | $1,174.90 | $1,548.82 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $17,378.01 / $26,302.68
| Facility | | $6,309.57 | $17,378.01 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,479.11 / $2,630.27
| Professional | | $1,047.13 | $1,479.11 | $2,630.27 |