- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,445.44 / $1,584.89
| Facility | | $1,258.93 | $1,445.44 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,148.15 / $1,412.54
| Professional | | $776.25 | $1,148.15 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $12,022.64 / $16,595.87
| Facility | | $12,022.64 | $12,022.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $616.60 / $794.33
| Professional | | $537.03 | $616.60 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $7,079.46 / $46,773.51
| Facility | | $549.54 | $7,079.46 | $46,773.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $11,481.54 / $21,877.62
| Facility | | $8,912.51 | $11,481.54 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $1,202.26 / $2,089.30
| Professional | | $562.34 | $1,202.26 | $2,089.30 |