- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $4,677.35 / $10,964.78
| Facility | | $1,174.90 | $4,677.35 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $223.87 / $281.84
| Professional | | $154.88 | $223.87 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $6,309.57 / $13,803.84
| Facility | | $3,311.31 | $6,309.57 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $251.19 / $501.19
| Professional | | $173.78 | $251.19 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $16,982.44 / $33,113.11
| Facility | | $457.09 | $16,982.44 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $1,202.26 / $1,202.26
| Professional | | $302.00 | $1,202.26 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,623.41 / $12,589.25
| Facility | | $1,862.09 | $5,623.41 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $323.59 / $588.84
| Professional | | $218.78 | $323.59 | $588.84 |