- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $10,964.78 / $17,378.01
| Facility | | $9,332.54 | $10,964.78 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $10,232.93 / $11,748.98
| Professional | | $4,265.80 | $10,232.93 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $8,511.38 / $8,511.38
| Facility | | $8,511.38 | $8,511.38 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,589.25 / $12,589.25 / $12,589.25
| Professional | | $12,589.25 | $12,589.25 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $64.57 / $70.79
| Professional | | $50.12 | $64.57 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $8,912.51 / $8,912.51
| Facility | | $5,495.41 | $8,912.51 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,456.54 / $16,218.10 / $16,218.10
| Professional | | $6,456.54 | $16,218.10 | $16,218.10 |