- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $7,762.47 / $8,709.64
| Facility | | $1,548.82 | $7,762.47 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $776.25 / $933.25
| Professional | | $588.84 | $776.25 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56,234.13 / $69,183.10 / $81,283.05
| Facility | | $56,234.13 | $69,183.10 | $81,283.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $977.24
| Professional | | $776.25 | $776.25 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $60.26 / $3,467.37
| Professional | | $50.12 | $60.26 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $933.25 / $977.24
| Facility | | $741.31 | $933.25 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $8,912.51 / $18,197.01
| Facility | | $891.25 | $8,912.51 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,230.27 / $1,659.59
| Professional | | $1,023.29 | $1,230.27 | $1,659.59 |