- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $6,309.57 / $21,877.62
| Facility | | $1,071.52 | $6,309.57 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $323.59 / $467.74
| Professional | | $281.84 | $323.59 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $11,748.98 / $24,547.09
| Facility | | $4,897.79 | $11,748.98 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $436.52 / $831.76
| Professional | | $302.00 | $436.52 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,148.15 / $22,908.68
| Facility | | $346.74 | $1,148.15 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $524.81 / $1,047.13
| Professional | | $338.84 | $524.81 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $9,549.93 / $25,703.96
| Facility | | $2,951.21 | $9,549.93 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $446.68 / $870.96
| Professional | | $309.03 | $446.68 | $870.96 |