- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,388.44 / $7,762.47
| Facility | | $1,071.52 | $3,388.44 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $2,398.83 / $8,912.51
| Professional | | $794.33 | $2,398.83 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $26,302.68 / $38,904.51
| Facility | | $15,848.93 | $26,302.68 | $38,904.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $660.69 / $3,311.31
| Professional | | $436.52 | $660.69 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $4,365.16 / $4,365.16
| Facility | | $4,365.16 | $4,365.16 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $10,232.93 / $26,302.68
| Facility | | $1,202.26 | $10,232.93 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,096.48 / $2,041.74
| Professional | | $676.08 | $1,096.48 | $2,041.74 |