- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $19,498.45 / $30,199.52
| Facility | | $10,715.19 | $19,498.45 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $2,344.23
| Professional | | $1,995.26 | $1,995.26 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $6,918.31 / $6,918.31
| Facility | | $6,918.31 | $6,918.31 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $3,548.13
| Professional | | $2,884.03 | $2,884.03 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,511.89 / $11,220.18
| Facility | | $1,479.11 | $2,511.89 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,511.89 / $7,943.28
| Professional | | $2,511.89 | $2,511.89 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $9,120.11 / $10,000.00
| Facility | | $8,709.64 | $9,120.11 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $5,623.41 / $5,623.41
| Professional | | $3,715.35 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,949.84 / $4,570.88
| Facility | | $1,479.11 | $1,949.84 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,344.23 / $2,511.89
| Professional | | $2,344.23 | $2,344.23 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $5,011.87 / $7,585.78
| Professional | | $1,122.02 | $5,011.87 | $7,585.78 |