- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,128.31 / $13,489.63
| Facility | | $5,011.87 | $8,128.31 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $194.98 / $338.84
| Facility | | $186.21 | $194.98 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $8,128.31 / $12,589.25
| Facility | | $331.13 | $8,128.31 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $281.84 / $575.44
| Professional | | $134.90 | $281.84 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $50.12 / $70.79
| Professional | | $50.12 | $50.12 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $7,413.10 / $10,964.78
| Facility | | $7,413.10 | $7,413.10 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,412.54 / $1,412.54
| Professional | | $933.25 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $10,232.93 / $11,220.18
| Facility | | $9,549.93 | $10,232.93 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $331.13 / $467.74
| Professional | | $141.25 | $331.13 | $467.74 |