- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,819.70 / $3,235.94
| Facility | | $1,096.48 | $1,819.70 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,047.13 / $1,288.25
| Professional | | $724.44 | $1,047.13 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $426.58
| Facility | | $426.58 | $426.58 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $426.58 / $426.58
| Professional | | $363.08 | $426.58 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $19,498.45 / $45,708.82
| Facility | | $1,584.89 | $19,498.45 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,862.09 / $24,547.09
| Professional | | $1,479.11 | $1,862.09 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $2,137.96 / $2,137.96
| Facility | | $870.96 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,456.54 / $6,456.54 / $6,456.54
| Professional | | $6,456.54 | $6,456.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $794.33 / $1,348.96
| Professional | | $562.34 | $794.33 | $1,348.96 |