- 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
- $741.31 / $933.25 / $3,981.07
| Professional | | $741.31 | $933.25 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $2,818.38 / $2,818.38
| Professional | | $2,818.38 | $2,818.38 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,122.02 / $5,495.41
| Facility | | $831.76 | $1,122.02 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,344.23 / $5,754.40
| Professional | | $1,819.70 | $2,344.23 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $3,388.44 / $4,677.35
| Professional | | $3,388.44 | $3,388.44 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $3,981.07 / $5,623.41
| Facility | | $1,122.02 | $3,981.07 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $776.25 / $2,818.38
| Professional | | $60.26 | $776.25 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,238.72 / $5,623.41
| Professional | | $2,137.96 | $2,238.72 | $5,623.41 |