- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $8,912.51 / $8,912.51
| Facility | | $8,912.51 | $8,912.51 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,317.64 / $9,772.37 / $12,882.50
| Professional | | $8,317.64 | $9,772.37 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,762.47 / $9,120.11 / $17,782.79
| Professional | | $7,762.47 | $9,120.11 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,659.59 / $9,332.54
| Facility | | $831.76 | $1,659.59 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,479.11 / $9,332.54
| Professional | | $1,071.52 | $1,479.11 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $10,000.00 / $10,964.78
| Facility | | $10,000.00 | $10,000.00 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,511.38 / $8,511.38 / $19,054.61
| Professional | | $8,511.38 | $8,511.38 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $10,000.00 / $10,964.78
| Facility | | $10,000.00 | $10,000.00 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $8,511.38 / $10,000.00
| Professional | | $1,230.27 | $8,511.38 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $1,412.54 / $8,511.38
| Professional | | $512.86 | $1,412.54 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,549.93 / $11,220.18 / $18,620.87
| Professional | | $9,549.93 | $11,220.18 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $1,174.90 / $7,244.36
| Facility | | $489.78 | $1,174.90 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $5,011.87 / $7,244.36
| Professional | | $3,235.94 | $5,011.87 | $7,244.36 |