- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,570.88 / $11,220.18
| Facility | | $1,584.89 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,737.80 / $3,467.37
| Professional | | $1,412.54 | $1,737.80 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $9,549.93 / $17,782.79
| Facility | | $3,630.78 | $9,549.93 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,137.96 / $3,890.45
| Professional | | $1,380.38 | $2,137.96 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,801.89 / $10,000.00
| Facility | | $398.11 | $3,801.89 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,398.83 / $4,786.30
| Professional | | $1,513.56 | $2,398.83 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,041.74 / $3,630.78
| Professional | | $1,380.38 | $2,041.74 | $3,630.78 |