- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $20,892.96 / $40,738.03
| Facility | | $5,888.44 | $20,892.96 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,888.44 / $6,760.83 / $9,332.54
| Professional | | $5,888.44 | $6,760.83 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,511.38 / $9,120.11 / $12,022.64
| Professional | | $8,511.38 | $9,120.11 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $20,892.96 / $48,977.88
| Facility | | $5,495.41 | $20,892.96 | $48,977.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $6,918.31 / $11,481.54
| Facility | | $5,623.41 | $6,918.31 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Professional | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $8,511.38 / $10,232.93
| Facility | | $7,585.78 | $8,511.38 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $5,128.61 / $8,511.38
| Professional | | $3,548.13 | $5,128.61 | $8,511.38 |