- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $13,803.84 / $18,620.87
| Facility | | $7,585.78 | $13,803.84 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,011.87 / $6,025.60 / $8,709.64
| Professional | | $5,011.87 | $6,025.60 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $10,232.93 / $10,232.93
| Facility | | $9,772.37 | $10,232.93 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $4,897.79 / $5,128.61
| Facility | | $4,897.79 | $4,897.79 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $21.38 / $50.12
| Professional | | $16.98 | $21.38 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $6,760.83 / $9,120.11
| Facility | | $6,760.83 | $6,760.83 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,570.88 / $16,982.44
| Professional | | $3,162.28 | $4,570.88 | $16,982.44 |