- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,092.16 / $24,184.31 / $29,144.84
| Facility | | $12,092.16 | $24,184.31 | $29,144.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.37 / $605.12 / $856.27
| Professional | | $530.37 | $605.12 | $856.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $609.96 / $743.12 / $1,142.40
| Professional | | $609.96 | $743.12 | $1,142.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $755.80 / $884.04 / $1,233.92
| Professional | | $755.80 | $884.04 | $1,233.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $637.29 / $709.40 / $1,103.83
| Professional | | $637.29 | $709.40 | $1,103.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,092.16 / $24,184.31 / $29,144.84
| Facility | | $12,092.16 | $24,184.31 | $29,144.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.50 / $607.03 / $906.93
| Professional | | $540.50 | $607.03 | $906.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.19 / $850.37 / $1,112.43
| Professional | | $676.19 | $850.37 | $1,112.43 |