- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $5,754.40 / $13,489.63
| Facility | | $1,412.54 | $5,754.40 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $588.84 / $933.25
| Professional | | $354.81 | $588.84 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $15,848.93 / $32,359.37
| Facility | | $5,888.44 | $15,848.93 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $489.78 / $1,096.48
| Professional | | $323.59 | $489.78 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $22,387.21 / $33,113.11
| Facility | | $616.60 | $22,387.21 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,737.80 / $1,737.80
| Professional | | $707.95 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $21,877.62 / $58,884.37
| Facility | | $5,754.40 | $21,877.62 | $58,884.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $1,071.52 / $1,862.09
| Professional | | $549.54 | $1,071.52 | $1,862.09 |