- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $8,128.31 / $40,738.03
| Facility | | $1,737.80 | $8,128.31 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,691.53 / $4,786.30
| Professional | | $1,737.80 | $2,691.53 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $16,982.44 / $41,686.94
| Facility | | $8,128.31 | $16,982.44 | $41,686.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $1,148.15 / $3,388.44
| Professional | | $467.74 | $1,148.15 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $14,454.40 / $48,977.88
| Facility | | $2,238.72 | $14,454.40 | $48,977.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $2,290.87 / $2,290.87
| Professional | | $831.76 | $2,290.87 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,623.41 / $12,302.69
| Facility | | $1,819.70 | $5,623.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $2,187.76 / $4,677.35
| Professional | | $741.31 | $2,187.76 | $4,677.35 |