- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $9,772.37 / $10,000.00
| Facility | | $2,398.83 | $9,772.37 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,884.03 / $5,495.41
| Professional | | $2,511.89 | $2,884.03 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $18,197.01 / $28,840.32
| Facility | | $5,623.41 | $18,197.01 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $5,370.32 / $7,762.47
| Professional | | $2,398.83 | $5,370.32 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,801.89 / $7,079.46
| Professional | | $1,000.00 | $3,801.89 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $3,388.44 / $7,413.10
| Facility | | $446.68 | $3,388.44 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,981.07 / $6,309.57
| Professional | | $2,818.38 | $3,981.07 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $3,388.44 / $7,413.10
| Facility | | $446.68 | $3,388.44 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $4,073.80 / $7,413.10
| Professional | | $2,754.23 | $4,073.80 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,818.38 / $3,467.37
| Facility | | $2,089.30 | $2,818.38 | $3,467.37 |