- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $18,197.01 / $28,840.32
| Facility | | $5,248.07 | $18,197.01 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $4,073.80 / $4,897.79
| Professional | | $2,818.38 | $4,073.80 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $15,135.61 / $25,118.86
| Facility | | $6,760.83 | $15,135.61 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $5,248.07
| Professional | | $2,187.76 | $2,187.76 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,388.44 / $15,848.93
| Facility | | $2,754.23 | $3,388.44 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $6,456.54 / $7,585.78
| Professional | | $6,309.57 | $6,456.54 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,244.36 / $7,244.36 / $7,413.10
| Professional | | $7,244.36 | $7,244.36 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $5,248.07 / $5,248.07
| Professional | | $3,630.78 | $5,248.07 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $3,162.28
| Professional | | $2,187.76 | $2,187.76 | $3,162.28 |