- 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
- $83.18 / $151.36 / $173.78
| Professional | | $83.18 | $151.36 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $2,511.89 / $2,951.21
| Facility | | $275.42 | $2,511.89 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $776.25
| Professional | | $776.25 | $776.25 | $776.25 |
- 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
- $114.82 / $123.03 / $162.18
| Professional | | $114.82 | $123.03 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $39.81 / $50.12
| Professional | | $33.11 | $39.81 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $10,232.93 / $15,848.93
| Facility | | $3,311.31 | $10,232.93 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $186.21 / $323.59
| Professional | | $125.89 | $186.21 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $245.47 / $245.47
| Professional | | $245.47 | $245.47 | $245.47 |