- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $7,413.10 / $14,125.38
| Facility | | $2,818.38 | $7,413.10 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $194.98 / $371.54
| Professional | | $48.98 | $194.98 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,908.68 / $27,542.29 / $33,884.42
| Facility | | $22,908.68 | $27,542.29 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $5,888.44 / $15,848.93
| Facility | | $346.74 | $5,888.44 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $67.61 / $2,754.23
| Professional | | $51.29 | $67.61 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $6,165.95 / $15,488.17
| Facility | | $2,570.40 | $6,165.95 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $67.61 / $229.09
| Professional | | $51.29 | $67.61 | $229.09 |