- 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
- $933.25 / $1,348.96 / $4,786.30
| Professional | | $933.25 | $1,348.96 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $977.24 / $2,818.38
| Professional | | $977.24 | $977.24 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,047.13 / $4,786.30
| Facility | | $954.99 | $1,047.13 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,290.87 / $4,786.30
| Professional | | $1,905.46 | $2,290.87 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,548.13 / $4,786.30
| Professional | | $3,090.30 | $3,548.13 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,096.48 / $6,760.83
| Facility | | $954.99 | $1,096.48 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $831.76 / $2,818.38
| Professional | | $60.26 | $831.76 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $2,290.87 / $6,918.31
| Professional | | $977.24 | $2,290.87 | $6,918.31 |