- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $15,848.93 / $28,183.83
| Facility | | $7,413.10 | $15,848.93 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $5,754.40 / $7,413.10
| Professional | | $2,691.53 | $5,754.40 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,549.93 / $9,549.93 / $9,549.93
| Professional | | $9,549.93 | $9,549.93 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $13,803.84 / $17,378.01
| Facility | | $6,918.31 | $13,803.84 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $7,585.78 / $10,232.93
| Facility | | $6,025.60 | $7,585.78 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,570.88 / $38,018.94
| Professional | | $3,162.28 | $4,570.88 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $7,585.78 / $9,120.11
| Facility | | $3,162.28 | $7,585.78 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,570.88 / $9,772.37
| Professional | | $3,162.28 | $4,570.88 | $9,772.37 |