- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $9,549.93 / $25,118.86
| Facility | | $4,677.35 | $9,549.93 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,168.69 / $5,370.32
| Professional | | $2,951.21 | $4,168.69 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $9,120.11 / $26,302.68
| Facility | | $4,168.69 | $9,120.11 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $72.44 / $6,606.93
| Professional | | $66.07 | $72.44 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $9,120.11 / $23,442.29
| Facility | | $3,548.13 | $9,120.11 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $7,943.28 / $15,135.61
| Professional | | $6,309.57 | $7,943.28 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $5,495.41 / $6,606.93
| Facility | | $3,311.31 | $5,495.41 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,311.31 / $6,606.93
| Professional | | $2,290.87 | $3,311.31 | $6,606.93 |