- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $12,022.64 / $16,595.87
| Facility | | $9,772.37 | $12,022.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $1,862.09 / $2,137.96
| Professional | | $549.54 | $1,862.09 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $954.99 / $2,454.71
| Facility | | $354.81 | $954.99 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $954.99 / $2,137.96
| Professional | | $354.81 | $954.99 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $10,715.19
| Professional | | $2,290.87 | $2,290.87 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,348.96 / $2,818.38
| Facility | | $954.99 | $1,348.96 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $5,011.87 / $11,481.54
| Professional | | $1,479.11 | $5,011.87 | $11,481.54 |