- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $7,413.10 / $13,803.84
| Facility | | $4,466.84 | $7,413.10 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $281.84 / $537.03
| Professional | | $239.88 | $281.84 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,801.89 / $12,882.50
| Facility | | $1,230.27 | $3,801.89 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $436.52 / $645.65
| Professional | | $281.84 | $436.52 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $10,000.00 / $15,848.93
| Facility | | $5,754.40 | $10,000.00 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,413.10 / $10,715.19 / $10,715.19
| Professional | | $7,413.10 | $10,715.19 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $7,079.46 / $12,022.64
| Facility | | $1,737.80 | $7,079.46 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $398.11 / $691.83
| Professional | | $275.42 | $398.11 | $691.83 |