- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $2,884.03 / $10,964.78
| Facility | | $2,630.27 | $2,884.03 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,818.38 / $2,884.03
| Professional | | $2,344.23 | $2,818.38 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,548.13 / $3,548.13
| Professional | | $2,630.27 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,570.88 / $10,000.00
| Facility | | $1,548.82 | $4,570.88 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $4,265.80 / $5,370.32
| Professional | | $33.88 | $4,265.80 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $16,595.87 / $16,595.87
| Facility | | $16,595.87 | $16,595.87 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,398.83 / $3,548.13
| Facility | | $1,258.93 | $2,398.83 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,089.30 / $3,548.13
| Professional | | $1,479.11 | $2,089.30 | $3,548.13 |