- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $4,168.69 / $11,220.18
| Facility | | $2,041.74 | $4,168.69 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,949.84 / $2,691.53
| Professional | | $1,584.89 | $1,949.84 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,073.80 / $11,748.98
| Facility | | $1,995.26 | $4,073.80 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $977.24 / $3,090.30
| Professional | | $120.23 | $977.24 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,890.45 / $10,000.00
| Facility | | $1,584.89 | $3,890.45 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,548.13 / $7,244.36
| Professional | | $2,818.38 | $3,548.13 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,454.71 / $2,951.21
| Facility | | $1,023.29 | $2,454.71 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,445.44 / $2,951.21
| Professional | | $1,023.29 | $1,445.44 | $2,951.21 |