- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,548.13 / $9,772.37
| Facility | | $1,096.48 | $3,548.13 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $2,818.38 / $10,715.19
| Professional | | $812.83 | $2,818.38 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $9,120.11 / $17,378.01
| Facility | | $3,801.89 | $9,120.11 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $501.19 / $1,047.13
| Professional | | $295.12 | $501.19 | $1,047.13 |
- 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
- $831.76 / $831.76 / $831.76
| Professional | | $831.76 | $831.76 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $1,412.54 / $4,073.80
| Facility | | $316.23 | $1,412.54 | $4,073.80 |