- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $7,585.78 / $17,378.01
| Facility | | $7,585.78 | $7,585.78 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $2,691.53 / $7,413.10
| Professional | | $2,691.53 | $2,691.53 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $12,589.25 / $20,417.38
| Facility | | $9,332.54 | $12,589.25 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $4,570.88 / $9,549.93
| Professional | | $2,818.38 | $4,570.88 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $26,302.68 / $38,018.94
| Facility | | $4,897.79 | $26,302.68 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,232.93 / $14,125.38 / $16,595.87
| Professional | | $10,232.93 | $14,125.38 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,570.88 / $13,182.57
| Professional | | $3,630.78 | $4,570.88 | $13,182.57 |