- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,481.14 / $10,399.70 / $48,362.60
| Facility | | $4,481.14 | $10,399.70 | $48,362.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,481.14 / $6,341.25 / $7,186.75
| Professional | | $4,481.14 | $6,341.25 | $7,186.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,264.76 / $18,636.04 / $38,743.76
| Facility | | $8,264.76 | $18,636.04 | $38,743.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,918.50 / $11,076.05 / $15,405.01
| Professional | | $5,918.50 | $11,076.05 | $15,405.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,346.00 / $3,346.00 / $8,702.00
| Facility | | $3,346.00 | $3,346.00 | $8,702.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,550.85 / $2,205.00 / $7,034.56
| Professional | | $1,550.85 | $2,205.00 | $7,034.56 |