- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $9,772.37 / $12,589.25
| Facility | | $8,511.38 | $9,772.37 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,570.88 / $5,888.44 / $7,244.36
| Professional | | $4,570.88 | $5,888.44 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $660.69 / $891.25
| Facility | | $549.54 | $660.69 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $602.56 / $5,495.41
| Professional | | $426.58 | $602.56 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $6,918.31 / $18,197.01
| Facility | | $5,370.32 | $6,918.31 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,548.13 / $7,585.78
| Facility | | $2,187.76 | $3,548.13 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,819.70 / $3,548.13
| Professional | | $1,548.82 | $1,819.70 | $3,548.13 |