- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $5,495.41 / $9,549.93
| Facility | | $2,511.89 | $5,495.41 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $457.09 / $1,148.15
| Professional | | $275.42 | $457.09 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $14,125.38 / $16,595.87
| Facility | | $7,943.28 | $14,125.38 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $645.65 / $870.96
| Professional | | $275.42 | $645.65 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $616.60 / $870.96
| Professional | | $416.87 | $616.60 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $549.54 / $691.83
| Professional | | $549.54 | $549.54 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $8,709.64 / $11,748.98
| Facility | | $5,754.40 | $8,709.64 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $501.19 / $891.25
| Professional | | $331.13 | $501.19 | $891.25 |