- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $10,964.78 / $11,220.18
| Facility | | $10,232.93 | $10,964.78 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $1,071.52 / $7,762.47
| Professional | | $562.34 | $1,071.52 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $6,165.95 / $6,165.95
| Facility | | $6,165.95 | $6,165.95 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,089.30 / $2,951.21
| Professional | | $1,380.38 | $2,089.30 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,412.54 / $2,570.40
| Professional | | $831.76 | $1,412.54 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $12,022.64 / $14,125.38
| Facility | | $4,168.69 | $12,022.64 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,348.96 / $3,162.28
| Professional | | $724.44 | $1,348.96 | $3,162.28 |