- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $4,897.79 / $11,220.18
| Facility | | $1,122.02 | $4,897.79 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $338.84 / $436.52
| Professional | | $218.78 | $338.84 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $40,738.03 / $57,543.99
| Facility | | $16,982.44 | $40,738.03 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $371.54 / $512.86
| Professional | | $316.23 | $371.54 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $5,248.07 / $43,651.58
| Facility | | $331.13 | $5,248.07 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $426.58
| Professional | | $426.58 | $426.58 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $7,762.47 / $10,964.78
| Facility | | $3,019.95 | $7,762.47 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $446.68 / $724.44
| Professional | | $316.23 | $446.68 | $724.44 |