- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $9,332.54 / $15,488.17
| Facility | | $4,466.84 | $9,332.54 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,047.13 / $3,162.28
| Professional | | $912.01 | $1,047.13 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,380.38 / $3,311.31
| Professional | | $831.76 | $1,380.38 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,230.27 / $1,621.81
| Professional | | $912.01 | $1,230.27 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $18,620.87 / $29,512.09
| Facility | | $12,022.64 | $18,620.87 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,096.48 / $2,344.23
| Professional | | $794.33 | $1,096.48 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $10,000.00 / $25,118.86
| Facility | | $4,786.30 | $10,000.00 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $977.24 / $2,137.96
| Professional | | $645.65 | $977.24 | $2,137.96 |