- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $9,120.11 / $16,595.87
| Facility | | $6,760.83 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $407.38 / $691.83
| Professional | | $363.08 | $407.38 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,137.96 / $2,238.72
| Facility | | $1,737.80 | $2,137.96 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $537.03 / $660.69
| Professional | | $501.19 | $537.03 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $9,120.11 / $11,748.98
| Facility | | $9,120.11 | $9,120.11 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $524.81 / $1,000.00
| Professional | | $158.49 | $524.81 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $512.86 / $1,023.29
| Facility | | $371.54 | $512.86 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Professional | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $11,220.18 / $17,378.01
| Facility | | $2,754.23 | $11,220.18 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $478.63 / $758.58
| Professional | | $354.81 | $478.63 | $758.58 |