- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $5,495.41 / $10,964.78
| Facility | | $1,047.13 | $5,495.41 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $194.98 / $309.03
| Professional | | $131.83 | $194.98 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.89 / $128.82 / $323.59
| Facility | | $125.89 | $128.82 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,023.29 / $1,023.29
| Professional | | $1,023.29 | $1,023.29 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,041.74 / $2,238.72
| Facility | | $1,905.46 | $2,041.74 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $302.00 / $331.13
| Professional | | $173.78 | $302.00 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $478.63 / $1,698.24
| Professional | | $32.36 | $478.63 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $7,585.78 / $12,022.64
| Facility | | $2,398.83 | $7,585.78 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $295.12 / $478.63
| Professional | | $208.93 | $295.12 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $363.08 / $363.08
| Professional | | $295.12 | $363.08 | $363.08 |