- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,031.20 / $6,037.44 / $10,062.40
| Facility | | $5,031.20 | $6,037.44 | $10,062.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,528.08 / $18,695.90 / $18,695.90
| Professional | | $4,528.08 | $18,695.90 | $18,695.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.89 / $652.76 / $878.17
| Facility | | $537.89 | $652.76 | $878.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.01 / $515.80 / $608.66
| Professional | | $351.01 | $515.80 | $608.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,204.87 / $3,957.04 / $10,890.03
| Facility | | $3,204.87 | $3,957.04 | $10,890.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,178.83 / $2,222.30 / $2,943.25
| Professional | | $2,178.83 | $2,222.30 | $2,943.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,113.10 / $2,113.10 / $3,018.72
| Professional | | $2,113.10 | $2,113.10 | $3,018.72 |