- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $5,495.41 / $9,549.93
| Facility | | $3,162.28 | $5,495.41 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $645.65 / $1,778.28
| Professional | | $537.03 | $645.65 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $17,378.01 / $26,915.35
| Facility | | $8,912.51 | $17,378.01 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $1,023.29 / $1,445.44
| Professional | | $549.54 | $1,023.29 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $13,803.84
| Facility | | $851.14 | $851.14 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,096.48 / $1,659.59
| Professional | | $691.83 | $1,096.48 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $870.96 / $1,202.26
| Professional | | $602.56 | $870.96 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $10,964.78 / $18,620.87
| Facility | | $7,244.36 | $10,964.78 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $891.25 / $1,621.81
| Professional | | $524.81 | $891.25 | $1,621.81 |