- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,238.72 / $2,818.38
| Facility | | $1,230.27 | $2,238.72 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $1,513.56
| Professional | | $1,230.27 | $1,230.27 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $64.57 / $64.57
| Facility | | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $2,187.76 / $3,467.37
| Facility | | $724.44 | $2,187.76 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $70.79 / $75.86
| Professional | | $60.26 | $70.79 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $1,949.84 / $1,949.84
| Facility | | $288.40 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,290.87 / $4,365.16
| Facility | | $1,659.59 | $2,290.87 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $363.08 / $363.08
| Professional | | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,951.21 / $5,370.32
| Facility | | $2,238.72 | $2,951.21 | $5,370.32 |