- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $12,022.64 / $16,595.87
| Facility | | $9,772.37 | $12,022.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,398.83 / $10,000.00
| Professional | | $1,659.59 | $2,398.83 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,623.41 / $5,623.41 / $5,623.41
| Professional | | $5,623.41 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $10,000.00 / $14,454.40
| Facility | | $1,995.26 | $10,000.00 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $2,041.74 / $10,000.00
| Professional | | $60.26 | $2,041.74 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,413.10 / $7,413.10 / $10,715.19
| Professional | | $7,413.10 | $7,413.10 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $10,000.00 / $14,454.40
| Facility | | $1,995.26 | $10,000.00 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $1,621.81 / $5,623.41
| Professional | | $60.26 | $1,621.81 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,890.45 / $8,912.51
| Professional | | $2,137.96 | $3,890.45 | $8,912.51 |