- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $5,370.32 / $11,748.98
| Facility | | $1,737.80 | $5,370.32 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $5,370.32 / $12,022.64
| Professional | | $1,047.13 | $5,370.32 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $7,585.78 / $15,848.93
| Facility | | $3,388.44 | $7,585.78 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $331.13 / $602.56
| Professional | | $281.84 | $331.13 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $21,379.62 / $53,703.18
| Facility | | $323.59 | $21,379.62 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.66 / $0.66 / $0.66
| Professional | | $0.66 | $0.66 | $0.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |