- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $6,760.83 / $8,317.64
| Facility | | $1,380.38 | $6,760.83 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $363.08 / $416.87
| Professional | | $363.08 | $363.08 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,388.44 / $3,388.44
| Professional | | $2,238.72 | $3,388.44 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $257.04 / $501.19
| Professional | | $223.87 | $257.04 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $389.05 / $478.63
| Facility | | $371.54 | $389.05 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $9,549.93 / $14,454.40
| Facility | | $2,818.38 | $9,549.93 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $575.44
| Professional | | $416.87 | $416.87 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45,708.82 / $45,708.82 / $45,708.82
| Facility | | $45,708.82 | $45,708.82 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,344.23 / $2,344.23
| Professional | | $2,041.74 | $2,344.23 | $2,344.23 |