- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,570.88 / $8,511.38
| Facility | | $2,290.87 | $4,570.88 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $1,096.48 / $5,754.40
| Professional | | $204.17 | $1,096.48 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $13,489.63 / $25,703.96
| Facility | | $10,964.78 | $13,489.63 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $512.86 / $4,570.88
| Professional | | $275.42 | $512.86 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Facility | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $660.69 / $8,511.38
| Professional | | $316.23 | $660.69 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $6,165.95 / $8,128.31
| Professional | | $3,090.30 | $6,165.95 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,467.37 / $6,760.83
| Facility | | $1,288.25 | $3,467.37 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $1,230.27 / $8,511.38
| Professional | | $229.09 | $1,230.27 | $8,511.38 |