- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $11,748.98 / $19,054.61
| Facility | | $7,079.46 | $11,748.98 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,762.47 / $8,317.64 / $9,772.37
| Professional | | $7,762.47 | $8,317.64 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $630.96 / $1,698.24
| Professional | | $141.25 | $630.96 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,011.87 / $7,079.46
| Facility | | $5,011.87 | $5,011.87 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,220.18 / $11,220.18 / $11,220.18
| Professional | | $11,220.18 | $11,220.18 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,760.83 / $6,760.83 / $6,760.83
| Professional | | $6,760.83 | $6,760.83 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,187.76 / $4,466.84
| Professional | | $1,621.81 | $2,187.76 | $4,466.84 |