- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,388.44 / $10,232.93
| Facility | | $1,096.48 | $3,388.44 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $54.95 / $346.74
| Professional | | $36.31 | $54.95 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,456.54 / $9,772.37
| Facility | | $2,454.71 | $6,456.54 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $72.44 / $114.82
| Professional | | $53.70 | $72.44 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $13,803.84 / $19,952.62
| Facility | | $12,302.69 | $13,803.84 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,547.09 / $24,547.09 / $24,547.09
| Facility | | $24,547.09 | $24,547.09 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,235.94 / $3,235.94
| Professional | | $2,691.53 | $3,235.94 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $10,232.93 / $19,952.62
| Facility | | $6,456.54 | $10,232.93 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $74.13 / $123.03
| Professional | | $47.86 | $74.13 | $123.03 |