- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $18,620.87 / $36,307.81
| Facility | | $5,248.07 | $18,620.87 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $5,888.44 / $6,456.54
| Professional | | $2,691.53 | $5,888.44 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,585.78 / $8,128.31 / $10,715.19
| Professional | | $7,585.78 | $8,128.31 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $19,054.61 / $43,651.58
| Facility | | $4,897.79 | $19,054.61 | $43,651.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $6,760.83 / $13,803.84
| Facility | | $5,623.41 | $6,760.83 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Professional | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $7,585.78 / $9,120.11
| Facility | | $6,760.83 | $7,585.78 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,570.88 / $7,585.78
| Professional | | $3,162.28 | $4,570.88 | $7,585.78 |