- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $4,897.79 / $7,244.36
| Facility | | $1,380.38 | $4,897.79 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $1,380.38
| Professional | | $724.44 | $724.44 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $14,454.40 / $19,498.45
| Facility | | $6,456.54 | $14,454.40 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $549.54 / $870.96
| Professional | | $331.13 | $549.54 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,651.58 / $52,480.75 / $66,069.34
| Facility | | $43,651.58 | $52,480.75 | $66,069.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $724.44
| Professional | | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $10,964.78 / $17,378.01
| Facility | | $5,128.61 | $10,964.78 | $17,378.01 |