- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $12,022.64 / $16,595.87
| Facility | | $5,370.32 | $12,022.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,398.83 / $10,000.00
| Professional | | $1,862.09 | $2,398.83 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,165.95 / $6,165.95 / $6,165.95
| Professional | | $6,165.95 | $6,165.95 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,691.53 / $14,125.38
| Facility | | $2,187.76 | $2,691.53 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $5,623.41 / $12,302.69
| Professional | | $4,365.16 | $5,623.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,760.83 / $7,244.36 / $10,232.93
| Professional | | $6,760.83 | $7,244.36 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $10,000.00 / $14,454.40
| Facility | | $2,691.53 | $10,000.00 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $1,737.80 / $6,165.95
| Professional | | $60.26 | $1,737.80 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,413.10 / $11,481.54
| Professional | | $2,454.71 | $7,413.10 | $11,481.54 |