- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $18,620.87 / $50,118.72
| Facility | | $7,943.28 | $18,620.87 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $9,549.93 / $15,135.61
| Professional | | $1,000.00 | $9,549.93 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $15,488.17 / $53,703.18
| Facility | | $10,000.00 | $15,488.17 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $4,786.30 / $14,454.40
| Professional | | $794.33 | $4,786.30 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $21,379.62 / $48,977.88
| Facility | | $7,762.47 | $21,379.62 | $48,977.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,623.41 / $14,454.40 / $28,840.32
| Professional | | $5,623.41 | $14,454.40 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $12,022.64 / $14,454.40
| Facility | | $5,011.87 | $12,022.64 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,244.36 / $13,803.84
| Professional | | $5,011.87 | $7,244.36 | $13,803.84 |