- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $14,454.40 / $57,543.99
| Facility | | $5,888.44 | $14,454.40 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $5,888.44 / $8,709.64
| Professional | | $2,691.53 | $5,888.44 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $6,309.57 / $18,197.01
| Facility | | $3,388.44 | $6,309.57 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $4,570.88
| Professional | | $851.14 | $851.14 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $8,912.51 / $22,908.68
| Facility | | $3,311.31 | $8,912.51 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,709.64 / $9,332.54 / $10,964.78
| Professional | | $8,709.64 | $9,332.54 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $7,585.78 / $7,943.28
| Professional | | $1,905.46 | $7,585.78 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,585.78 / $7,585.78 / $7,585.78
| Professional | | $7,585.78 | $7,585.78 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $5,248.07 / $5,248.07
| Facility | | $5,248.07 | $5,248.07 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $7,943.28
| Professional | | $3,162.28 | $3,162.28 | $7,943.28 |