- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $12,022.64 / $16,595.87
| Facility | | $9,772.37 | $12,022.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $933.25 / $1,479.11
| Professional | | $602.56 | $933.25 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $794.33 / $1,122.02
| Facility | | $389.05 | $794.33 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $776.25 / $954.99
| Professional | | $173.78 | $776.25 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,511.89 / $5,248.07
| Professional | | $2,511.89 | $2,511.89 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,096.48 / $1,122.02
| Facility | | $794.33 | $1,096.48 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $1,584.89 / $3,548.13
| Professional | | $562.34 | $1,584.89 | $3,548.13 |