- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $7,079.46 / $16,982.44
| Facility | | $1,995.26 | $7,079.46 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,737.80 / $2,398.83
| Professional | | $1,258.93 | $1,737.80 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $15,135.61 / $34,673.69
| Facility | | $5,754.40 | $15,135.61 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,041.74 / $3,890.45
| Professional | | $1,479.11 | $2,041.74 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,570.40 / $10,000.00
| Facility | | $398.11 | $2,570.40 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $4,466.84 / $7,244.36
| Professional | | $3,019.95 | $4,466.84 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,691.53 / $4,570.88
| Professional | | $1,778.28 | $2,691.53 | $4,570.88 |