- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $9,120.11 / $16,595.87
| Facility | | $1,862.09 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $1,862.09 / $2,137.96
| Professional | | $1,862.09 | $1,862.09 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $537.03 / $616.60
| Facility | | $34.67 | $537.03 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $524.81 / $891.25
| Professional | | $346.74 | $524.81 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,041.74 / $3,981.07
| Facility | | $1,862.09 | $2,041.74 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $4,466.84 / $4,466.84
| Professional | | $4,466.84 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Professional | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $6,309.57 / $9,120.11
| Facility | | $478.63 | $6,309.57 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,943.28 / $7,943.28 / $8,128.31
| Professional | | $7,943.28 | $7,943.28 | $8,128.31 |