- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,480.40 / $7,885.19 / $44,478.70
| Facility | | $2,480.40 | $7,885.19 | $44,478.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,480.40 / $2,480.40 / $7,776.00
| Professional | | $2,480.40 | $2,480.40 | $7,776.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,601.04 / $17,139.87 / $35,632.35
| Facility | | $7,601.04 | $17,139.87 | $35,632.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,632.39 / $9,038.00 / $16,676.63
| Professional | | $4,632.39 | $9,038.00 | $16,676.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,443.20 / $8,164.80 / $11,275.20
| Professional | | $5,443.20 | $8,164.80 | $11,275.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,711.10 / $2,711.10 / $8,702.00
| Facility | | $2,711.10 | $2,711.10 | $8,702.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,276.80 / $4,276.80 / $7,776.00
| Facility | | $4,276.80 | $4,276.80 | $7,776.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,265.92 / $4,665.60 / $7,931.52
| Professional | | $3,265.92 | $4,665.60 | $7,931.52 |