- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,570.88 / $6,025.60
| Facility | | $3,162.28 | $4,570.88 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,168.69 / $8,709.64
| Professional | | $3,388.44 | $4,168.69 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $4,786.30 / $8,128.31
| Professional | | $676.08 | $4,786.30 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $7,762.47
| Professional | | $32.36 | $33.11 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,011.87 / $6,025.60 / $7,762.47
| Professional | | $5,011.87 | $6,025.60 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $7,079.46 / $10,000.00
| Professional | | $3,548.13 | $7,079.46 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,754.40 / $8,317.64
| Professional | | $4,466.84 | $5,754.40 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,128.61 / $13,803.84
| Facility | | $2,290.87 | $5,128.61 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,168.69 / $6,760.83
| Professional | | $3,311.31 | $4,168.69 | $6,760.83 |