- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,803.71 / $7,900.71 / $28,798.50
| Facility | | $5,803.71 | $7,900.71 | $28,798.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,285.12 / $6,515.49 / $7,117.76
| Professional | | $3,285.12 | $6,515.49 | $7,117.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,928.55 / $10,692.52 / $16,848.29
| Facility | | $5,928.55 | $10,692.52 | $16,848.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $896.87 / $986.55 / $1,095.07
| Professional | | $896.87 | $986.55 | $1,095.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,475.20 / $5,475.20 / $5,475.20
| Facility | | $5,475.20 | $5,475.20 | $5,475.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,558.88 / $4,409.45 / $41,568.97
| Facility | | $3,558.88 | $4,409.45 | $41,568.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,299.58 / $2,737.60 / $7,117.76
| Professional | | $2,299.58 | $2,737.60 | $7,117.76 |