- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $12,022.64 / $16,595.87
| Facility | | $4,365.16 | $12,022.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,698.24 / $6,918.31
| Professional | | $1,479.11 | $1,698.24 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $4,677.35 / $4,677.35
| Professional | | $4,677.35 | $4,677.35 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,187.76 / $9,772.37
| Facility | | $1,584.89 | $2,187.76 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,981.07 / $10,000.00
| Professional | | $3,090.30 | $3,981.07 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,754.40 / $5,754.40 / $8,128.31
| Professional | | $5,754.40 | $5,754.40 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $6,918.31 / $10,000.00
| Facility | | $2,187.76 | $6,918.31 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $1,318.26 / $4,677.35
| Professional | | $60.26 | $1,318.26 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $3,715.35 / $8,511.38
| Professional | | $3,630.78 | $3,715.35 | $8,511.38 |