- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,126.32 / $15,363.84 / $26,939.14
| Facility | | $10,126.32 | $15,363.84 | $26,939.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $916.38 / $1,299.55 / $3,126.23
| Facility | | $916.38 | $1,299.55 | $3,126.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.26 / $429.39 / $524.35
| Professional | | $425.26 | $429.39 | $524.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $744.95 / $1,188.09 / $2,461.60
| Facility | | $744.95 | $1,188.09 | $2,461.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.46 / $375.72 / $412.88
| Professional | | $367.46 | $375.72 | $412.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $659.12 / $1,071.67 / $15,441.19
| Facility | | $659.12 | $1,071.67 | $15,441.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.96 / $1,256.84 / $2,698.77
| Professional | | $534.96 | $1,256.84 | $2,698.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $570.62 / $1,277.04 / $2,627.96
| Professional | | $570.62 | $1,277.04 | $2,627.96 |