- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $6,760.83 / $19,952.62
| Facility | | $3,388.44 | $6,760.83 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,995.26 / $3,801.89
| Professional | | $1,659.59 | $1,995.26 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,548.13 / $23,988.33
| Facility | | $1,230.27 | $3,548.13 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,818.38 / $4,073.80
| Professional | | $1,862.09 | $2,818.38 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $2,511.89 / $3,090.30
| Facility | | $501.19 | $2,511.89 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,884.03 / $4,677.35
| Professional | | $1,949.84 | $2,884.03 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,754.23 / $10,000.00
| Professional | | $1,995.26 | $2,754.23 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $3,388.44
| Professional | | $3,235.94 | $3,235.94 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $8,912.51 / $19,498.45
| Facility | | $2,290.87 | $8,912.51 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,454.71 / $4,168.69
| Professional | | $1,584.89 | $2,454.71 | $4,168.69 |