- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $6,456.54 / $19,498.45
| Facility | | $1,122.02 | $6,456.54 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $446.68 / $1,096.48
| Professional | | $354.81 | $446.68 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $13,803.84 / $36,307.81
| Facility | | $5,011.87 | $13,803.84 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $588.84 / $1,096.48
| Professional | | $346.74 | $588.84 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $18,197.01 / $95,499.26
| Facility | | $602.56 | $18,197.01 | $95,499.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $645.65 / $1,202.26
| Professional | | $389.05 | $645.65 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $24,547.09 / $85,113.80
| Facility | | $6,918.31 | $24,547.09 | $85,113.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $549.54 / $933.25
| Professional | | $346.74 | $549.54 | $933.25 |