- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $5,248.07 / $8,709.64
| Facility | | $1,778.28 | $5,248.07 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $588.84 / $1,905.46
| Professional | | $371.54 | $588.84 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $9,332.54 / $16,218.10
| Facility | | $6,456.54 | $9,332.54 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $602.56 / $977.24
| Professional | | $549.54 | $602.56 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $870.96 / $870.96
| Professional | | $870.96 | $870.96 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54,954.09 / $54,954.09 / $57,543.99
| Facility | | $54,954.09 | $54,954.09 | $57,543.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $6,025.60 / $66,069.34
| Facility | | $389.05 | $6,025.60 | $66,069.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $891.25 / $4,466.84
| Professional | | $602.56 | $891.25 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,413.10 / $30,902.95
| Facility | | $4,570.88 | $7,413.10 | $30,902.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $870.96 / $1,445.44
| Professional | | $588.84 | $870.96 | $1,445.44 |