- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,354.09 / $4,853.22 / $15,880.90
| Facility | | $3,354.09 | $4,853.22 | $15,880.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,769.45 / $10,047.70 / $11,829.70
| Professional | | $9,769.45 | $10,047.70 | $11,829.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,053.10 / $5,215.76 / $7,331.46
| Facility | | $3,053.10 | $5,215.76 | $7,331.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $597.91 / $657.70 / $730.05
| Professional | | $597.91 | $657.70 | $730.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,916.60 / $2,916.60 / $2,916.60
| Facility | | $2,916.60 | $2,916.60 | $2,916.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,051.94 / $5,595.42 / $20,599.72
| Facility | | $3,051.94 | $5,595.42 | $20,599.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,224.97 / $1,749.96 / $4,374.89
| Professional | | $1,224.97 | $1,749.96 | $4,374.89 |