- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $7,413.10 / $16,982.44
| Facility | | $2,344.23 | $7,413.10 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $204.17 / $467.74
| Professional | | $173.78 | $204.17 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $11,220.18 / $20,892.96
| Facility | | $4,466.84 | $11,220.18 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $588.84 / $1,862.09
| Professional | | $208.93 | $588.84 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $10,964.78 / $26,302.68
| Facility | | $3,162.28 | $10,964.78 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $870.96 / $870.96
| Professional | | $251.19 | $870.96 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $10,232.93 / $23,988.33
| Facility | | $3,311.31 | $10,232.93 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $251.19 / $457.09
| Professional | | $173.78 | $251.19 | $457.09 |