- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $4,897.79 / $6,918.31
| Facility | | $4,365.16 | $4,897.79 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,467.37 / $6,309.57
| Professional | | $2,818.38 | $3,467.37 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $5,128.61 / $5,128.61
| Facility | | $5,128.61 | $5,128.61 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $7,585.78 / $7,585.78
| Professional | | $1,023.29 | $7,585.78 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,715.35 / $6,165.95
| Professional | | $2,454.71 | $3,715.35 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $4,897.79 / $8,317.64
| Facility | | $4,365.16 | $4,897.79 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,548.13 / $4,786.30
| Professional | | $2,884.03 | $3,548.13 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,548.13 / $5,623.41
| Professional | | $2,454.71 | $3,548.13 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $10,000.00 / $19,054.61
| Facility | | $5,011.87 | $10,000.00 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,548.13 / $4,786.30
| Professional | | $3,019.95 | $3,548.13 | $4,786.30 |