- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,786.30 / $11,220.18
| Facility | | $1,584.89 | $4,786.30 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,890.45 / $10,964.78
| Professional | | $1,000.00 | $3,890.45 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $7,585.78 / $15,488.17
| Facility | | $3,311.31 | $7,585.78 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $407.38 / $660.69
| Professional | | $275.42 | $407.38 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $758.58 / $50,118.72
| Facility | | $323.59 | $758.58 | $50,118.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $5,370.32 / $12,302.69
| Facility | | $1,548.82 | $5,370.32 | $12,302.69 |