- 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
- $1,737.80 / $2,041.74 / $4,570.88
| Professional | | $1,737.80 | $2,041.74 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $10,000.00 / $18,620.87
| Facility | | $3,630.78 | $10,000.00 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,570.40 / $4,786.30
| Professional | | $1,819.70 | $2,570.40 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $6,025.60 / $16,982.44
| Facility | | $323.59 | $6,025.60 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,951.21 / $6,456.54
| Professional | | $1,862.09 | $2,951.21 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $7,244.36 / $16,218.10
| Facility | | $2,511.89 | $7,244.36 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,398.83 / $4,466.84
| Professional | | $1,659.59 | $2,398.83 | $4,466.84 |