- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $13,803.84 / $16,595.87
| Facility | | $9,772.37 | $13,803.84 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,168.69 / $5,623.41 / $13,803.84
| Professional | | $4,168.69 | $5,623.41 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,570.88 / $6,456.54 / $15,848.93
| Professional | | $4,570.88 | $6,456.54 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $6,606.93 / $18,197.01
| Facility | | $4,677.35 | $6,606.93 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,000.00 / $14,454.40 / $28,183.83
| Professional | | $10,000.00 | $14,454.40 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,481.54 / $19,054.61 / $27,542.29
| Professional | | $11,481.54 | $19,054.61 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $7,244.36 / $18,197.01
| Facility | | $4,897.79 | $7,244.36 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $6,760.83 / $15,848.93
| Professional | | $60.26 | $6,760.83 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $12,589.25 / $30,199.52
| Professional | | $4,365.16 | $12,589.25 | $30,199.52 |