- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $12,022.64 / $17,782.79
| Facility | | $6,456.54 | $12,022.64 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $660.69 / $1,445.44
| Professional | | $398.11 | $660.69 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,754.40 / $11,748.98
| Facility | | $5,011.87 | $5,754.40 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $707.95 / $1,513.56
| Professional | | $588.84 | $707.95 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $676.08 / $1,737.80
| Professional | | $363.08 | $676.08 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $602.56 / $1,096.48
| Professional | | $446.68 | $602.56 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $588.84 / $1,122.02
| Professional | | $446.68 | $588.84 | $1,122.02 |