- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $12,022.64 / $16,595.87
| Facility | | $5,370.32 | $12,022.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,344.23 / $10,000.00
| Professional | | $1,819.70 | $2,344.23 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,025.60 / $6,025.60 / $6,025.60
| Professional | | $6,025.60 | $6,025.60 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,630.27 / $13,803.84
| Facility | | $2,137.96 | $2,630.27 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $5,495.41 / $12,022.64
| Professional | | $4,265.80 | $5,495.41 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,606.93 / $7,244.36 / $10,000.00
| Professional | | $6,606.93 | $7,244.36 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $10,000.00 / $14,125.38
| Facility | | $2,630.27 | $10,000.00 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $1,737.80 / $6,025.60
| Professional | | $60.26 | $1,737.80 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,244.36 / $11,220.18
| Professional | | $2,454.71 | $7,244.36 | $11,220.18 |