- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $4,677.35 / $10,964.78
| Facility | | $1,258.93 | $4,677.35 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $398.11 / $1,479.11
| Professional | | $263.03 | $398.11 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $7,585.78 / $15,488.17
| Facility | | $3,311.31 | $7,585.78 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $416.87 / $831.76
| Professional | | $281.84 | $416.87 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $13,803.84
| Facility | | $812.83 | $812.83 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $2,454.71 / $2,454.71
| Professional | | $549.54 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,495.41 / $12,302.69
| Facility | | $1,862.09 | $5,495.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $478.63 / $870.96
| Professional | | $338.84 | $478.63 | $870.96 |