- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $8,128.31 / $19,498.45
| Facility | | $6,025.60 | $8,128.31 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $4,168.69 / $5,011.87
| Professional | | $2,818.38 | $4,168.69 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $5,248.07 / $15,848.93
| Facility | | $5,248.07 | $5,248.07 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,905.46 / $3,981.07
| Professional | | $1,621.81 | $1,905.46 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $75,857.76 / $114,815.36
| Facility | | $5,011.87 | $75,857.76 | $114,815.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $3,388.44 / $20,417.38
| Facility | | $3,388.44 | $3,388.44 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,309.57 / $15,848.93
| Professional | | $2,511.89 | $6,309.57 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $5,248.07 / $5,248.07
| Facility | | $5,248.07 | $5,248.07 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,162.28 / $5,248.07
| Professional | | $2,187.76 | $3,162.28 | $5,248.07 |