- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $6,165.95 / $10,964.78
| Facility | | $4,570.88 | $6,165.95 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $524.81 / $645.65
| Professional | | $398.11 | $524.81 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $17,378.01 / $36,307.81
| Facility | | $9,120.11 | $17,378.01 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $1,096.48 / $1,412.54
| Professional | | $549.54 | $1,096.48 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Professional | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $13,489.63 / $19,498.45
| Facility | | $5,888.44 | $13,489.63 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $812.83 / $1,584.89
| Professional | | $524.81 | $812.83 | $1,584.89 |