- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $7,585.78 / $9,332.54
| Facility | | $4,786.30 | $7,585.78 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,786.30 / $7,585.78 / $10,000.00
| Professional | | $4,786.30 | $7,585.78 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $831.76 / $23,988.33
| Facility | | $831.76 | $831.76 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $6,309.57 / $12,589.25
| Professional | | $4,677.35 | $6,309.57 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $5,128.61 / $6,165.95
| Facility | | $5,128.61 | $5,128.61 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $5,128.61 / $18,620.87
| Professional | | $4,365.16 | $5,128.61 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $1,318.26 / $5,623.41
| Facility | | $389.05 | $1,318.26 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $4,073.80 / $6,918.31
| Professional | | $2,818.38 | $4,073.80 | $6,918.31 |