- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $15,848.93 / $24,547.09
| Facility | | $6,760.83 | $15,848.93 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,691.53 / $4,073.80
| Professional | | $1,000.00 | $2,691.53 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,511.38 / $15,488.17
| Facility | | $5,011.87 | $8,511.38 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $537.03 / $616.60
| Facility | | $34.67 | $537.03 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,570.88 / $5,495.41 / $6,606.93
| Professional | | $4,570.88 | $5,495.41 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,801.89 / $3,981.07
| Facility | | $2,630.27 | $3,801.89 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $467.74 / $524.81
| Professional | | $436.52 | $467.74 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $16,982.44 / $25,703.96
| Facility | | $1,698.24 | $16,982.44 | $25,703.96 |