- 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
- $1,445.44 / $1,862.09 / $8,128.31
| Professional | | $1,445.44 | $1,862.09 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,011.87 / $5,011.87
| Professional | | $5,011.87 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,238.72 / $11,481.54
| Facility | | $1,698.24 | $2,238.72 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,365.16 / $10,000.00
| Professional | | $3,388.44 | $4,365.16 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,888.44 / $8,317.64
| Professional | | $5,495.41 | $5,888.44 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $8,128.31 / $11,748.98
| Facility | | $2,238.72 | $8,128.31 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $1,445.44 / $5,011.87
| Professional | | $60.26 | $1,445.44 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,168.69 / $9,549.93
| Professional | | $2,344.23 | $4,168.69 | $9,549.93 |