- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $12,022.64 / $16,595.87
| Facility | | $4,897.79 | $12,022.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,187.76 / $4,897.79
| Professional | | $1,548.82 | $2,187.76 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,073.80 / $5,495.41 / $7,244.36
| Professional | | $4,073.80 | $5,495.41 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,454.71 / $10,964.78
| Facility | | $1,584.89 | $2,454.71 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $5,495.41 / $10,000.00
| Professional | | $4,265.80 | $5,495.41 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,495.41 / $7,079.46 / $10,232.93
| Professional | | $5,495.41 | $7,079.46 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,344.23 / $8,709.64
| Facility | | $1,621.81 | $2,344.23 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $2,398.83 / $5,495.41
| Professional | | $60.26 | $2,398.83 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $4,466.84 / $10,964.78
| Professional | | $2,041.74 | $4,466.84 | $10,964.78 |