- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $23,442.29 / $45,708.82
| Facility | | $5,888.44 | $23,442.29 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,128.61 / $6,025.60 / $7,244.36
| Professional | | $5,128.61 | $6,025.60 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $6,456.54 / $34,673.69
| Facility | | $4,365.16 | $6,456.54 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,232.93 / $12,302.69 / $40,738.03
| Professional | | $10,232.93 | $12,302.69 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $5,128.61 / $5,128.61
| Professional | | $3,090.30 | $5,128.61 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,128.61 / $6,918.31 / $7,585.78
| Professional | | $5,128.61 | $6,918.31 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,548.13 / $8,511.38
| Facility | | $2,187.76 | $3,548.13 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,548.82 / $5,754.40
| Professional | | $1,288.25 | $1,548.82 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,128.61 / $5,128.61
| Professional | | $2,290.87 | $5,128.61 | $5,128.61 |