- 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
- $1,174.90 / $1,288.25 / $5,128.61
| Professional | | $1,174.90 | $1,288.25 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $3,388.44 / $3,388.44
| Professional | | $3,388.44 | $3,388.44 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,548.82 / $7,079.46
| Facility | | $1,202.26 | $1,548.82 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,162.28 / $7,244.36
| Professional | | $2,454.71 | $3,162.28 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $4,466.84 / $6,025.60
| Professional | | $4,365.16 | $4,466.84 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $5,128.61 / $7,244.36
| Facility | | $1,548.82 | $5,128.61 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $977.24 / $3,388.44
| Professional | | $60.26 | $977.24 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $2,691.53 / $6,165.95
| Professional | | $2,630.27 | $2,691.53 | $6,165.95 |