- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $11,481.54 / $26,915.35
| Facility | | $5,370.32 | $11,481.54 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,981.07 / $3,981.07 / $5,495.41
| Professional | | $3,981.07 | $3,981.07 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $15,488.17 / $37,153.52
| Facility | | $10,964.78 | $15,488.17 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $5,888.44 / $15,848.93
| Professional | | $1,071.52 | $5,888.44 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $7,244.36 / $12,882.50
| Facility | | $2,951.21 | $7,244.36 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $3,890.45 / $9,549.93
| Professional | | $575.44 | $3,890.45 | $9,549.93 |