- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $10,471.29 / $18,197.01
| Facility | | $7,943.28 | $10,471.29 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $794.33 / $912.01
| Professional | | $346.74 | $794.33 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,905.46 / $2,137.96
| Facility | | $1,445.44 | $1,905.46 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $8,912.51 / $8,912.51
| Facility | | $8,912.51 | $8,912.51 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $794.33 / $1,380.38
| Facility | | $346.74 | $794.33 | $1,380.38 |
- 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
- $8,317.64 / $22,387.21 / $37,153.52
| Facility | | $8,317.64 | $22,387.21 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $1,047.13 / $1,995.26
| Professional | | $501.19 | $1,047.13 | $1,995.26 |