- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $4,786.30 / $8,511.38
| Facility | | $3,090.30 | $4,786.30 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $6,760.83 / $17,378.01
| Facility | | $2,344.23 | $6,760.83 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $10,000.00 / $13,489.63
| Facility | | $4,897.79 | $10,000.00 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $6,918.31 / $20,417.38
| Facility | | $2,691.53 | $6,918.31 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,952.62 / $37,153.52 / $52,480.75
| Professional | | $19,952.62 | $37,153.52 | $52,480.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $6,760.83 / $17,378.01
| Facility | | $2,691.53 | $6,760.83 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $7,244.36 / $29,512.09
| Facility | | $2,691.53 | $7,244.36 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,498.45 / $25,703.96 / $47,863.01
| Professional | | $19,498.45 | $25,703.96 | $47,863.01 |