- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,521.67 / $5,043.35 / $6,404.52
| Facility | | $2,521.67 | $5,043.35 | $6,404.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.83 / $268.80 / $709.53
| Professional | | $239.83 | $268.80 | $709.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,656.00 / $3,200.76 / $3,200.76
| Facility | | $2,656.00 | $3,200.76 | $3,200.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.87 / $307.87 / $479.95
| Professional | | $243.87 | $307.87 | $479.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,809.64 / $5,472.74 / $9,943.36
| Facility | | $4,809.64 | $5,472.74 | $9,943.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.70 / $272.70 / $272.70
| Professional | | $272.70 | $272.70 | $272.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,027.00 / $1,485.00 / $1,485.00
| Facility | | $1,027.00 | $1,485.00 | $1,485.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.18 / $284.94 / $591.74
| Professional | | $220.18 | $284.94 | $591.74 |