- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $9,772.37 / $10,000.00
| Facility | | $2,398.83 | $9,772.37 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,884.03 / $5,128.61
| Professional | | $2,511.89 | $2,884.03 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $8,511.38 / $13,182.57
| Facility | | $3,890.45 | $8,511.38 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $5,370.32 / $7,762.47
| Professional | | $2,454.71 | $5,370.32 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $4,168.69 / $7,244.36
| Professional | | $794.33 | $4,168.69 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $3,388.44 / $7,413.10
| Facility | | $446.68 | $3,388.44 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,073.80 / $6,456.54
| Professional | | $2,884.03 | $4,073.80 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $3,388.44 / $7,413.10
| Facility | | $446.68 | $3,388.44 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $4,168.69 / $7,413.10
| Professional | | $2,754.23 | $4,168.69 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,884.03 / $3,388.44
| Facility | | $1,995.26 | $2,884.03 | $3,388.44 |