- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $12,302.69 / $28,840.32
| Facility | | $5,888.44 | $12,302.69 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,715.19 / $10,715.19 / $14,791.08
| Professional | | $10,715.19 | $10,715.19 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,512.09 / $41,686.94 / $100,000.00
| Facility | | $29,512.09 | $41,686.94 | $100,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,235.94 / $43,651.58
| Professional | | $1,445.44 | $3,235.94 | $43,651.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $14,791.08 / $25,703.96
| Facility | | $4,897.79 | $14,791.08 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $10,964.78 / $26,915.35
| Professional | | $776.25 | $10,964.78 | $26,915.35 |