- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $4,897.79 / $4,897.79
| Facility | | $1,380.38 | $4,897.79 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $134.90 / $173.78
| Professional | | $83.18 | $134.90 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $19,952.62 / $27,542.29
| Facility | | $8,709.64 | $19,952.62 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $398.11 / $933.25
| Professional | | $288.40 | $398.11 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $2,454.71 / $43,651.58
| Facility | | $154.88 | $2,454.71 | $43,651.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $3,388.44 / $3,388.44
| Facility | | $3,388.44 | $3,388.44 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $9,549.93 / $16,218.10
| Facility | | $3,890.45 | $9,549.93 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $181.97 / $316.23
| Professional | | $141.25 | $181.97 | $316.23 |