- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $8,709.64 / $8,912.51
| Facility | | $5,495.41 | $8,709.64 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,128.61 / $5,754.40 / $13,803.84
| Professional | | $5,128.61 | $5,754.40 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,128.61 / $7,079.46 / $10,000.00
| Professional | | $5,128.61 | $7,079.46 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,786.30 / $8,912.51 / $11,481.54
| Professional | | $4,786.30 | $8,912.51 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $8,511.38
| Professional | | $32.36 | $33.11 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $8,317.64 / $14,125.38
| Facility | | $6,025.60 | $8,317.64 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,786.30 / $8,511.38 / $11,481.54
| Professional | | $4,786.30 | $8,511.38 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $5,128.61 / $19,498.45
| Facility | | $3,090.30 | $5,128.61 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $8,709.64 / $14,125.38
| Professional | | $6,309.57 | $8,709.64 | $14,125.38 |