- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $7,585.78 / $16,595.87
| Facility | | $2,344.23 | $7,585.78 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $316.23 / $724.44
| Professional | | $269.15 | $316.23 | $724.44 |
- 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
- $245.47 / $602.56 / $1,862.09
| Professional | | $245.47 | $602.56 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $11,220.18 / $26,302.68
| Facility | | $5,128.61 | $11,220.18 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $1,318.26 / $1,318.26
| Professional | | $363.08 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $7,244.36 / $16,218.10
| Facility | | $2,398.83 | $7,244.36 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $398.11 / $707.95
| Professional | | $275.42 | $398.11 | $707.95 |