- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $7,079.46 / $11,481.54
| Facility | | $4,168.69 | $7,079.46 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $346.74 / $446.68
| Professional | | $263.03 | $346.74 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $7,762.47 / $21,877.62
| Facility | | $2,511.89 | $7,762.47 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $363.08 / $398.11
| Professional | | $354.81 | $363.08 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $512.86 / $741.31
| Professional | | $398.11 | $512.86 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $13,803.84 / $43,651.58
| Facility | | $5,754.40 | $13,803.84 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $549.54 / $954.99
| Professional | | $380.19 | $549.54 | $954.99 |