- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $8,511.38 / $20,417.38
| Facility | | $6,309.57 | $8,511.38 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $4,365.16 / $5,370.32
| Professional | | $3,548.13 | $4,365.16 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $16,595.87
| Facility | | $5,495.41 | $5,495.41 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,698.24 / $3,548.13
| Professional | | $1,698.24 | $1,698.24 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $79,432.82 / $120,226.44
| Facility | | $5,248.07 | $79,432.82 | $120,226.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $21,379.62
| Facility | | $3,548.13 | $3,548.13 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $6,606.93 / $16,595.87
| Professional | | $33.11 | $6,606.93 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $5,495.41
| Facility | | $5,495.41 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,311.31 / $5,495.41
| Professional | | $2,290.87 | $3,311.31 | $5,495.41 |