- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $4,677.35 / $14,454.40
| Facility | | $1,148.15 | $4,677.35 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $380.19 / $489.78
| Professional | | $239.88 | $380.19 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,915.35 / $32,359.37 / $38,018.94
| Facility | | $26,915.35 | $32,359.37 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $199.53 / $346.74
| Professional | | $120.23 | $199.53 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $21,877.62 / $52,480.75
| Facility | | $4,265.80 | $21,877.62 | $52,480.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $575.44 / $912.01
| Professional | | $426.58 | $575.44 | $912.01 |