- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $5,011.87 / $12,302.69
| Facility | | $1,584.89 | $5,011.87 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,445.44 / $3,467.37
| Professional | | $1,230.27 | $1,445.44 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $10,232.93 / $20,417.38
| Facility | | $3,630.78 | $10,232.93 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,819.70 / $3,467.37
| Professional | | $1,230.27 | $1,819.70 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,884.03 / $10,000.00
| Facility | | $398.11 | $2,884.03 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,995.26 / $4,265.80
| Professional | | $1,288.25 | $1,995.26 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $7,079.46 / $16,218.10
| Facility | | $2,398.83 | $7,079.46 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,584.89 / $2,951.21
| Professional | | $1,148.15 | $1,584.89 | $2,951.21 |