- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,902.17 / $7,255.42 / $31,321.60
| Facility | | $2,902.17 | $7,255.42 | $31,321.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,902.17 / $4,271.12 / $4,654.43
| Professional | | $2,902.17 | $4,271.12 | $4,654.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,352.59 / $8,089.15 / $17,242.47
| Facility | | $5,352.59 | $8,089.15 | $17,242.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,749.59 / $7,173.30 / $9,976.91
| Professional | | $5,749.59 | $7,173.30 | $9,976.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,833.06 / $5,475.80 / $12,381.00
| Facility | | $3,833.06 | $5,475.80 | $12,381.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,833.06 / $3,833.06 / $3,833.06
| Professional | | $3,833.06 | $3,833.06 | $3,833.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,299.84 / $3,285.48 / $5,585.32
| Professional | | $2,299.84 | $3,285.48 | $5,585.32 |