- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $8,912.51 / $14,791.08
| Facility | | $3,311.31 | $8,912.51 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $812.83 / $1,023.29
| Professional | | $645.65 | $812.83 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54,954.09 / $117,489.76 / $186,208.71
| Facility | | $54,954.09 | $117,489.76 | $186,208.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $60.26 / $85.11
| Professional | | $60.26 | $60.26 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $1,819.70 / $1,819.70
| Facility | | $1,819.70 | $1,819.70 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $33,884.42 / $138,038.43
| Facility | | $5,888.44 | $33,884.42 | $138,038.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,380.38 / $1,905.46
| Professional | | $1,047.13 | $1,380.38 | $1,905.46 |