- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $6,918.31 / $10,964.78
| Facility | | $4,466.84 | $6,918.31 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $616.60 / $3,388.44
| Professional | | $524.81 | $616.60 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $812.83 / $1,949.84
| Professional | | $549.54 | $812.83 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $724.44 / $1,000.00
| Professional | | $562.34 | $724.44 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,791.08 / $23,988.33 / $36,307.81
| Facility | | $14,791.08 | $23,988.33 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $812.83 / $2,344.23
| Professional | | $549.54 | $812.83 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $10,000.00 / $25,118.86
| Facility | | $4,786.30 | $10,000.00 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $630.96 / $1,479.11
| Professional | | $457.09 | $630.96 | $1,479.11 |