- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $8,912.51 / $9,772.37
| Facility | | $2,398.83 | $8,912.51 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,951.21 / $5,888.44
| Professional | | $2,454.71 | $2,951.21 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $21,877.62 / $34,673.69
| Facility | | $10,000.00 | $21,877.62 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $5,248.07 / $7,413.10
| Professional | | $2,511.89 | $5,248.07 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $5,495.41
| Facility | | $5,495.41 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $4,265.80 / $7,585.78
| Professional | | $3,090.30 | $4,265.80 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $7,413.10 / $7,413.10
| Facility | | $7,413.10 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,265.80 / $6,606.93
| Professional | | $2,951.21 | $4,265.80 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $7,413.10 / $7,413.10
| Facility | | $7,413.10 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,801.89 / $7,079.46
| Professional | | $2,754.23 | $3,801.89 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $1,905.46 / $3,090.30
| Facility | | $1,905.46 | $1,905.46 | $3,090.30 |