- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $9,120.11 / $23,988.33
| Facility | | $4,466.84 | $9,120.11 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,168.69 / $5,754.40
| Professional | | $3,235.94 | $4,168.69 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $8,709.64 / $26,302.68
| Facility | | $3,981.07 | $8,709.64 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $79.43 / $6,918.31
| Professional | | $66.07 | $79.43 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $8,709.64 / $22,908.68
| Facility | | $3,388.44 | $8,709.64 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,025.60 / $7,585.78 / $14,454.40
| Professional | | $6,025.60 | $7,585.78 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $5,248.07 / $6,309.57
| Facility | | $2,187.76 | $5,248.07 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,162.28 / $6,309.57
| Professional | | $2,187.76 | $3,162.28 | $6,309.57 |