- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $11,481.54 / $27,542.29
| Facility | | $11,481.54 | $11,481.54 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,481.54 / $11,481.54 / $11,481.54
| Professional | | $11,481.54 | $11,481.54 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $5,370.32 / $26,915.35
| Facility | | $2,754.23 | $5,370.32 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.48 / $114.82 / $186.21
| Professional | | $11.48 | $114.82 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $64.57 / $14,454.40
| Facility | | $64.57 | $64.57 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,888.44 / $5,888.44 / $5,888.44
| Professional | | $5,888.44 | $5,888.44 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,786.30 / $12,302.69
| Facility | | $1,584.89 | $4,786.30 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,413.10 / $17,782.79 / $47,863.01
| Professional | | $7,413.10 | $17,782.79 | $47,863.01 |