- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,063.44 / $3,843.88 / $15,447.50
| Facility | | $3,063.44 | $3,843.88 | $15,447.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.68 / $3,808.72 / $5,027.41
| Professional | | $380.68 | $3,808.72 | $5,027.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.42 / $966.38 / $3,898.64
| Facility | | $385.42 | $966.38 | $3,898.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,660.83 / $4,576.04 / $5,051.96
| Professional | | $3,660.83 | $4,576.04 | $5,051.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,453.62 / $3,660.83 / $3,660.83
| Facility | | $3,453.62 | $3,660.83 | $3,660.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,660.83 / $3,660.83 / $3,660.83
| Professional | | $3,660.83 | $3,660.83 | $3,660.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $610.66 / $4,228.27 / $8,844.66
| Facility | | $610.66 | $4,228.27 | $8,844.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,195.07 / $5,195.07 / $5,195.07
| Professional | | $5,195.07 | $5,195.07 | $5,195.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,660.83 / $3,660.83 / $3,660.83
| Professional | | $3,660.83 | $3,660.83 | $3,660.83 |