- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $5,888.44 / $47,863.01
| Facility | | $5,888.44 | $5,888.44 | $47,863.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $5,888.44 / $6,309.57
| Professional | | $2,454.71 | $5,888.44 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,623.41 / $6,165.95 / $6,760.83
| Professional | | $5,623.41 | $6,165.95 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $13,182.57 / $29,512.09
| Facility | | $12,589.25 | $13,182.57 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $24,547.09 / $60,255.96
| Professional | | $4,677.35 | $24,547.09 | $60,255.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,912.51 / $15,848.93 / $15,848.93
| Professional | | $8,912.51 | $15,848.93 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $9,332.54 / $9,332.54
| Facility | | $9,332.54 | $9,332.54 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,467.37 / $9,772.37
| Professional | | $3,235.94 | $3,467.37 | $9,772.37 |