- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $10,000.00 / $52,480.75
| Facility | | $2,454.71 | $10,000.00 | $52,480.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,388.44 / $9,772.37
| Professional | | $2,187.76 | $3,388.44 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $17,378.01 / $41,686.94
| Facility | | $5,754.40 | $17,378.01 | $41,686.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,318.26 / $3,981.07
| Professional | | $851.14 | $1,318.26 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $19,054.61 / $48,977.88
| Facility | | $1,412.54 | $19,054.61 | $48,977.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $2,818.38 / $2,818.38
| Professional | | $512.86 | $2,818.38 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $7,244.36 / $15,848.93
| Facility | | $2,290.87 | $7,244.36 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $3,019.95 / $6,165.95
| Professional | | $457.09 | $3,019.95 | $6,165.95 |