- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,834.13 / $5,909.48 / $13,841.56
| Facility | | $2,834.13 | $5,909.48 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,057.17 / $8,057.17 / $8,057.17
| Professional | | $8,057.17 | $8,057.17 | $8,057.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,100.60 / $4,495.00 / $7,888.43
| Facility | | $3,100.60 | $4,495.00 | $7,888.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $662.70 / $662.70 / $662.70
| Professional | | $662.70 | $662.70 | $662.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,735.97 / $7,772.00 / $13,616.62
| Facility | | $4,735.97 | $7,772.00 | $13,616.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,738.52 / $4,326.14 / $6,161.49
| Facility | | $3,738.52 | $4,326.14 | $6,161.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,966.19 / $5,356.00 / $7,934.00
| Facility | | $2,966.19 | $5,356.00 | $7,934.00 |