- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $7,244.36 / $33,113.11
| Facility | | $7,079.46 | $7,244.36 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,365.16 / $5,128.61
| Professional | | $2,951.21 | $4,365.16 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $12,022.64 / $12,882.50
| Facility | | $5,370.32 | $12,022.64 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,754.40 / $7,244.36 / $11,748.98
| Professional | | $5,754.40 | $7,244.36 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $11,481.54 / $29,512.09
| Facility | | $134.90 | $11,481.54 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $4,365.16 / $5,495.41
| Professional | | $4,365.16 | $4,365.16 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,495.41 / $11,220.18
| Facility | | $2,570.40 | $5,495.41 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,311.31 / $5,754.40
| Professional | | $2,187.76 | $3,311.31 | $5,754.40 |