- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $5,248.07 / $10,471.29
| Facility | | $4,570.88 | $5,248.07 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,801.89 / $6,918.31
| Professional | | $3,162.28 | $3,801.89 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $12,302.69 / $13,803.84
| Facility | | $7,413.10 | $12,302.69 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $6,606.93 / $9,120.11
| Professional | | $3,548.13 | $6,606.93 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,748.98 / $14,125.38 / $16,982.44
| Professional | | $11,748.98 | $14,125.38 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $5,495.41 / $6,760.83
| Professional | | $4,265.80 | $5,495.41 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $4,786.30 / $10,000.00
| Facility | | $758.58 | $4,786.30 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $4,466.84 / $10,232.93
| Professional | | $3,019.95 | $4,466.84 | $10,232.93 |