- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $6,025.60 / $14,454.40
| Facility | | $1,548.82 | $6,025.60 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $380.19 / $489.78
| Professional | | $269.15 | $380.19 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $7,585.78 / $28,840.32
| Facility | | $3,801.89 | $7,585.78 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $398.11 / $812.83
| Professional | | $275.42 | $398.11 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $22,908.68 / $33,884.42
| Facility | | $616.60 | $22,908.68 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $1,737.80 / $1,737.80
| Professional | | $524.81 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $21,877.62 / $58,884.37
| Facility | | $5,754.40 | $21,877.62 | $58,884.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $549.54 / $977.24
| Professional | | $371.54 | $549.54 | $977.24 |