- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $10,471.29 / $26,915.35
| Facility | | $3,981.07 | $10,471.29 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,890.45 / $5,011.87
| Professional | | $3,235.94 | $3,890.45 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $8,128.31 / $12,022.64
| Facility | | $2,511.89 | $8,128.31 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,128.61 / $10,000.00
| Professional | | $5,011.87 | $5,128.61 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $3,981.07 / $14,454.40
| Facility | | $2,951.21 | $3,981.07 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,248.07 / $9,549.93
| Facility | | $3,467.37 | $5,248.07 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $26,302.68
| Professional | | $2,187.76 | $2,187.76 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $5,248.07 / $6,309.57
| Facility | | $4,677.35 | $5,248.07 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $3,162.28
| Professional | | $2,187.76 | $2,187.76 | $3,162.28 |