- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $9,772.37 / $12,882.50
| Facility | | $8,511.38 | $9,772.37 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,128.61 / $7,413.10 / $9,772.37
| Professional | | $5,128.61 | $7,413.10 | $9,772.37 |
- 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
- $645.65 / $870.96 / $5,495.41
| Professional | | $645.65 | $870.96 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $7,244.36 / $18,197.01
| Facility | | $6,760.83 | $7,244.36 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $7,585.78 / $8,511.38
| Facility | | $3,548.13 | $7,585.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $5,128.61
| Professional | | $3,548.13 | $3,548.13 | $5,128.61 |