- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,085.49 / $11,461.80 / $31,026.20
| Facility | | $7,085.49 | $11,461.80 | $31,026.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,480.40 / $5,209.92 / $6,251.90
| Professional | | $2,480.40 | $5,209.92 | $6,251.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,561.62 / $9,728.26 / $15,410.94
| Facility | | $2,561.62 | $9,728.26 | $15,410.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,758.45 / $5,466.84 / $26,480.01
| Professional | | $3,758.45 | $5,466.84 | $26,480.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,194.28 / $12,636.00 / $22,744.80
| Facility | | $5,194.28 | $12,636.00 | $22,744.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,541.49 / $5,841.98 / $7,764.65
| Professional | | $3,541.49 | $5,841.98 | $7,764.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,209.92 / $7,776.00 / $14,196.93
| Facility | | $5,209.92 | $7,776.00 | $14,196.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,265.92 / $3,265.92 / $38,724.48
| Professional | | $3,265.92 | $3,265.92 | $38,724.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,265.92 / $3,265.92 / $4,665.60
| Professional | | $3,265.92 | $3,265.92 | $4,665.60 |