- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $5,623.41 / $8,511.38
| Facility | | $2,511.89 | $5,623.41 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,248.07 / $5,754.40 / $13,803.84
| Professional | | $5,248.07 | $5,754.40 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,786.30 / $10,000.00
| Facility | | $2,238.72 | $4,786.30 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,495.41 / $7,079.46 / $10,715.19
| Professional | | $5,495.41 | $7,079.46 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,248.07 / $6,165.95 / $8,912.51
| Professional | | $5,248.07 | $6,165.95 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $7,943.28 / $13,489.63
| Professional | | $602.56 | $7,943.28 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $5,623.41 / $17,378.01
| Facility | | $54.95 | $5,623.41 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,495.41 / $7,943.28 / $40,738.03
| Professional | | $5,495.41 | $7,943.28 | $40,738.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,818.38 / $10,471.29
| Facility | | $1,380.38 | $2,818.38 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,495.41 / $6,760.83 / $11,220.18
| Professional | | $5,495.41 | $6,760.83 | $11,220.18 |