- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,897.79 / $11,481.54
| Facility | | $1,819.70 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $2,951.21
| Professional | | $1,995.26 | $1,995.26 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $10,000.00 / $17,782.79
| Facility | | $3,630.78 | $10,000.00 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,890.45 / $5,623.41
| Professional | | $2,454.71 | $3,890.45 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $1,000.00 / $13,489.63
| Facility | | $34.67 | $1,000.00 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $3,715.35 / $7,585.78
| Professional | | $426.58 | $3,715.35 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,818.38 / $9,772.37
| Facility | | $537.03 | $2,818.38 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $3,019.95 / $12,589.25
| Professional | | $1,659.59 | $3,019.95 | $12,589.25 |