- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,949.84 / $4,677.35
| Facility | | $1,445.44 | $1,949.84 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,047.13 / $1,202.26
| Professional | | $831.76 | $1,047.13 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,258.93 / $3,801.89
| Facility | | $1,258.93 | $1,258.93 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.41 / $7.41 / $15.85
| Professional | | $7.41 | $7.41 | $15.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $18,197.01 / $27,542.29
| Facility | | $1,230.27 | $18,197.01 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $4,897.79
| Facility | | $812.83 | $812.83 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.77 / $1,548.82 / $3,801.89
| Professional | | $9.77 | $1,548.82 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,258.93 / $1,258.93
| Facility | | $1,258.93 | $1,258.93 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $758.58 / $1,258.93
| Professional | | $524.81 | $758.58 | $1,258.93 |