- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $12,022.64 / $16,595.87
| Facility | | $8,128.31 | $12,022.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,548.13 / $15,135.61
| Professional | | $2,754.23 | $3,548.13 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,332.54 / $9,332.54 / $9,332.54
| Professional | | $9,332.54 | $9,332.54 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,981.07 / $21,379.62
| Facility | | $3,235.94 | $3,981.07 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $8,128.31 / $18,620.87
| Professional | | $6,309.57 | $8,128.31 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,000.00 / $10,964.78 / $15,135.61
| Professional | | $10,000.00 | $10,964.78 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $15,135.61 / $21,877.62
| Facility | | $3,981.07 | $15,135.61 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $2,630.27 / $9,332.54
| Professional | | $60.26 | $2,630.27 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $11,220.18 / $16,982.44
| Professional | | $2,630.27 | $11,220.18 | $16,982.44 |