- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $6,025.60 / $14,454.40
| Facility | | $1,548.82 | $6,025.60 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $354.81 / $446.68
| Professional | | $245.47 | $354.81 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $7,585.78 / $28,840.32
| Facility | | $3,801.89 | $7,585.78 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $363.08 / $758.58
| Professional | | $275.42 | $363.08 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $22,387.21 / $33,113.11
| Facility | | $616.60 | $22,387.21 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $1,737.80 / $1,737.80
| Professional | | $467.74 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $21,877.62 / $58,884.37
| Facility | | $5,754.40 | $21,877.62 | $58,884.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $489.78 / $891.25
| Professional | | $338.84 | $489.78 | $891.25 |