- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $16,595.87 / $31,622.78
| Facility | | $4,677.35 | $16,595.87 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $5,248.07 / $7,413.10
| Professional | | $4,677.35 | $5,248.07 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,760.83 / $7,244.36 / $9,549.93
| Professional | | $6,760.83 | $7,244.36 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $16,595.87 / $38,018.94
| Facility | | $4,365.16 | $16,595.87 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $5,495.41 / $8,511.38
| Facility | | $4,073.80 | $5,495.41 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $6,760.83 / $8,128.31
| Facility | | $6,025.60 | $6,760.83 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $4,073.80 / $6,760.83
| Professional | | $2,818.38 | $4,073.80 | $6,760.83 |