- 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
- $1,202.26 / $28,183.83 / $66,069.34
| Facility | | $1,202.26 | $28,183.83 | $66,069.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $14,454.40 / $34,673.69
| Professional | | $1,445.44 | $14,454.40 | $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 / $7,244.36 / $17,378.01
| Professional | | $741.31 | $7,244.36 | $17,378.01 |