- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $12,302.69 / $28,840.32
| Facility | | $5,888.44 | $12,302.69 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,709.64 / $8,709.64 / $11,748.98
| Professional | | $8,709.64 | $8,709.64 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $28,183.83 / $66,069.34
| Facility | | $1,230.27 | $28,183.83 | $66,069.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $3,162.28 / $34,673.69
| Professional | | $1,479.11 | $3,162.28 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $9,772.37 / $17,782.79
| Facility | | $3,388.44 | $9,772.37 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $8,317.64 / $20,417.38
| Professional | | $741.31 | $8,317.64 | $20,417.38 |