- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,995.26 / $7,585.78
| Facility | | $1,071.52 | $1,995.26 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $2,398.83 / $8,317.64
| Professional | | $707.95 | $2,398.83 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $8,709.64 / $12,022.64
| Facility | | $8,709.64 | $8,709.64 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,023.29 / $7,413.10
| Professional | | $776.25 | $1,023.29 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $11,481.54 / $11,481.54
| Facility | | $11,481.54 | $11,481.54 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,698.24 / $10,471.29
| Professional | | $1,047.13 | $1,698.24 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $7,762.47 / $15,135.61
| Facility | | $2,884.03 | $7,762.47 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,548.82 / $9,772.37
| Professional | | $741.31 | $1,548.82 | $9,772.37 |