- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $7,585.78 / $26,915.35
| Facility | | $5,495.41 | $7,585.78 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $4,073.80 / $6,606.93
| Professional | | $2,818.38 | $4,073.80 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $10,232.93 / $16,218.10
| Facility | | $5,623.41 | $10,232.93 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $977.24 / $977.24
| Professional | | $891.25 | $977.24 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $5,248.07 / $5,248.07
| Facility | | $5,248.07 | $5,248.07 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,073.80 / $39,810.72
| Facility | | $3,388.44 | $4,073.80 | $39,810.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $5,248.07 / $5,248.07
| Facility | | $2,187.76 | $5,248.07 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,630.27 / $7,244.36
| Professional | | $2,187.76 | $2,630.27 | $7,244.36 |