- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $12,022.64 / $16,595.87
| Facility | | $5,011.87 | $12,022.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,290.87 / $9,332.54
| Professional | | $1,659.59 | $2,290.87 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,025.60 / $6,025.60 / $6,025.60
| Professional | | $6,025.60 | $6,025.60 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,454.71 / $13,182.57
| Facility | | $1,949.84 | $2,454.71 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $4,897.79 / $11,481.54
| Professional | | $3,801.89 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,165.95 / $6,606.93 / $10,000.00
| Professional | | $6,165.95 | $6,606.93 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $9,332.54 / $13,489.63
| Facility | | $2,454.71 | $9,332.54 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $1,621.81 / $6,025.60
| Professional | | $60.26 | $1,621.81 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,309.57 / $10,964.78
| Professional | | $2,454.71 | $6,309.57 | $10,964.78 |