- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $7,244.36 / $16,595.87
| Facility | | $2,041.74 | $7,244.36 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $851.14 / $1,096.48
| Professional | | $630.96 | $851.14 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $9,549.93 / $29,512.09
| Facility | | $4,786.30 | $9,549.93 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $588.84 / $1,258.93
| Professional | | $338.84 | $588.84 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $25,703.96 / $33,884.42
| Facility | | $1,513.56 | $25,703.96 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,778.28 / $3,981.07
| Professional | | $1,174.90 | $1,778.28 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $22,908.68 / $63,095.73
| Facility | | $5,754.40 | $22,908.68 | $63,095.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,230.27 / $2,238.72
| Professional | | $851.14 | $1,230.27 | $2,238.72 |