- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $9,120.11 / $16,595.87
| Facility | | $6,760.83 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $512.86 / $588.84
| Professional | | $512.86 | $512.86 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $10,715.19 / $10,715.19
| Facility | | $10,715.19 | $10,715.19 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $912.01 / $1,122.02
| Professional | | $851.14 | $912.01 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $575.44
| Facility | | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $263.03 / $630.96
| Professional | | $251.19 | $263.03 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $616.60 / $1,096.48
| Facility | | $512.86 | $616.60 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $676.08 / $794.33
| Professional | | $630.96 | $676.08 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $16,982.44 / $25,703.96
| Facility | | $6,309.57 | $16,982.44 | $25,703.96 |