- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $4,677.35 / $10,964.78
| Facility | | $1,202.26 | $4,677.35 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $346.74 / $436.52
| Professional | | $245.47 | $346.74 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $11,481.54 / $26,915.35
| Facility | | $5,128.61 | $11,481.54 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $436.52 / $776.25
| Professional | | $309.03 | $436.52 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $50,118.72
| Facility | | $588.84 | $588.84 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $691.83 / $1,659.59
| Professional | | $478.63 | $691.83 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $5,623.41 / $12,589.25
| Facility | | $1,905.46 | $5,623.41 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $478.63 / $870.96
| Professional | | $331.13 | $478.63 | $870.96 |