- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,143.69 / $9,724.86 / $35,447.50
| Facility | | $7,143.69 | $9,724.86 | $35,447.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,043.60 / $8,019.80 / $8,761.12
| Professional | | $4,043.60 | $8,019.80 | $8,761.12 |
- 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
- $6,739.33 / $6,739.33 / $6,739.33
| Facility | | $6,739.33 | $6,739.33 | $6,739.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,380.56 / $47,599.31 / $51,168.15
| Facility | | $4,380.56 | $47,599.31 | $51,168.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,830.52 / $3,628.66 / $8,761.12
| Professional | | $2,830.52 | $3,628.66 | $8,761.12 |