- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $8,511.38 / $60,255.96
| Facility | | $3,162.28 | $8,511.38 | $60,255.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $2,691.53 / $41,686.94
| Facility | | $177.83 | $2,691.53 | $41,686.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $3,019.95 / $5,370.32
| Professional | | $234.42 | $3,019.95 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $50.12 / $60.26
| Professional | | $32.36 | $50.12 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,915.35 / $26,915.35 / $26,915.35
| Facility | | $26,915.35 | $26,915.35 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $416.87 / $616.60
| Professional | | $229.09 | $416.87 | $616.60 |