- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $6,456.54 / $14,125.38
| Facility | | $1,230.27 | $6,456.54 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $1,659.59 / $5,370.32
| Professional | | $575.44 | $1,659.59 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $12,589.25 / $53,703.18
| Facility | | $398.11 | $12,589.25 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $12,022.64 / $23,442.29
| Facility | | $6,165.95 | $12,022.64 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $380.19 / $575.44
| Professional | | $39.81 | $380.19 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $10,232.93 / $15,848.93
| Facility | | $3,311.31 | $10,232.93 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $39.81 / $60.26
| Professional | | $34.67 | $39.81 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $331.13
| Professional | | $331.13 | $331.13 | $331.13 |