- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $10,000.00 / $20,417.38
| Facility | | $2,344.23 | $10,000.00 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,041.74 / $7,585.78
| Professional | | $1,513.56 | $2,041.74 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,288.25 / $4,265.80
| Professional | | $1,288.25 | $1,288.25 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,698.24 / $7,585.78
| Facility | | $1,548.82 | $1,698.24 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,630.78 / $7,585.78
| Professional | | $3,019.95 | $3,630.78 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,623.41 / $7,413.10
| Professional | | $4,466.84 | $5,623.41 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,737.80 / $10,715.19
| Facility | | $1,548.82 | $1,737.80 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $1,202.26 / $4,265.80
| Professional | | $60.26 | $1,202.26 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,235.94 / $10,232.93
| Professional | | $1,445.44 | $3,235.94 | $10,232.93 |