- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $12,022.64 / $28,840.32
| Facility | | $5,623.41 | $12,022.64 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $5,754.40 / $7,413.10
| Professional | | $2,691.53 | $5,754.40 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $12,302.69 / $36,307.81
| Facility | | $4,897.79 | $12,302.69 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,023.29 / $7,943.28
| Professional | | $851.14 | $1,023.29 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $14,454.40 / $33,884.42
| Facility | | $4,897.79 | $14,454.40 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,709.64 / $10,964.78 / $22,387.21
| Professional | | $8,709.64 | $10,964.78 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,585.78 / $9,120.11
| Facility | | $4,570.88 | $7,585.78 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,570.88 / $9,120.11
| Professional | | $3,162.28 | $4,570.88 | $9,120.11 |