- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,779.64 / $6,490.25 / $15,093.60
| Facility | | $4,779.64 | $6,490.25 | $15,093.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.03 / $8,880.07 / $32,350.60
| Professional | | $0.03 | $8,880.07 | $32,350.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,641.74 / $5,066.39 / $11,168.85
| Facility | | $3,641.74 | $5,066.39 | $11,168.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,264.04 / $3,641.74 / $5,756.88
| Professional | | $2,264.04 | $3,641.74 | $5,756.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,036.22 / $10,766.18 / $20,546.20
| Facility | | $5,036.22 | $10,766.18 | $20,546.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,365.77 / $6,245.23 / $11,321.89
| Professional | | $3,365.77 | $6,245.23 | $11,321.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,521.84 / $6,662.62 / $9,559.28
| Professional | | $3,521.84 | $6,662.62 | $9,559.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,314.35 / $3,018.72 / $8,829.25
| Professional | | $2,314.35 | $3,018.72 | $8,829.25 |