- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $6,456.54 / $16,595.87
| Facility | | $3,311.31 | $6,456.54 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,884.03 / $3,548.13
| Professional | | $2,290.87 | $2,884.03 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $6,025.60 / $17,782.79
| Facility | | $2,398.83 | $6,025.60 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.30 / $208.93 / $4,073.80
| Professional | | $12.30 | $208.93 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $6,456.54 / $16,218.10
| Facility | | $2,398.83 | $6,456.54 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $5,370.32 / $10,000.00
| Professional | | $4,265.80 | $5,370.32 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,715.35 / $4,365.16
| Facility | | $2,187.76 | $3,715.35 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,187.76 / $4,365.16
| Professional | | $1,548.82 | $2,187.76 | $4,365.16 |