- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $6,606.93 / $15,488.17
| Facility | | $1,949.84 | $6,606.93 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $186.21 / $371.54
| Professional | | $46.77 | $186.21 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $9,332.54 / $26,915.35
| Facility | | $4,570.88 | $9,332.54 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $371.54 / $645.65
| Professional | | $50.12 | $371.54 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $8,912.51 / $33,884.42
| Facility | | $630.96 | $8,912.51 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $1,778.28 / $1,778.28
| Professional | | $83.18 | $1,778.28 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $10,964.78 / $25,703.96
| Facility | | $3,630.78 | $10,964.78 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $72.44 / $416.87
| Professional | | $47.86 | $72.44 | $416.87 |