- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $7,079.46 / $16,982.44
| Facility | | $1,819.70 | $7,079.46 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $436.52 / $537.03
| Professional | | $302.00 | $436.52 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $15,135.61 / $34,673.69
| Facility | | $5,888.44 | $15,135.61 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $512.86 / $954.99
| Professional | | $363.08 | $512.86 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $15,848.93 / $36,307.81
| Facility | | $1,949.84 | $15,848.93 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $588.84 / $691.83
| Professional | | $489.78 | $588.84 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $3,162.28 / $10,232.93
| Facility | | $831.76 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $602.56 / $1,071.52
| Professional | | $407.38 | $602.56 | $1,071.52 |