- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $19,952.62 / $37,153.52
| Facility | | $5,370.32 | $19,952.62 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $5,011.87 / $7,585.78
| Professional | | $2,691.53 | $5,011.87 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,513.56 / $2,951.21
| Facility | | $1,174.90 | $1,513.56 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,964.78 / $11,748.98 / $12,302.69
| Professional | | $10,964.78 | $11,748.98 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,120.11 / $14,454.40 / $18,197.01
| Professional | | $9,120.11 | $14,454.40 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $5,011.87 / $36,307.81
| Facility | | $2,754.23 | $5,011.87 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,570.88 / $21,877.62
| Professional | | $3,162.28 | $4,570.88 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,120.11 / $9,120.11 / $9,120.11
| Professional | | $9,120.11 | $9,120.11 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $7,244.36 / $15,135.61
| Facility | | $3,162.28 | $7,244.36 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $4,570.88 / $7,585.78
| Professional | | $4,365.16 | $4,570.88 | $7,585.78 |