- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,786.39 / $14,254.50 / $23,353.20
| Facility | | $5,786.39 | $14,254.50 | $23,353.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,666.54 / $2,666.54 / $5,519.74
| Professional | | $2,666.54 | $2,666.54 | $5,519.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.32 / $981.67 / $9,841.69
| Professional | | $719.32 | $981.67 | $9,841.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,582.20 / $22,177.94 / $177,423.50
| Facility | | $7,582.20 | $22,177.94 | $177,423.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,926.37 / $18,197.28 / $178,343.28
| Professional | | $7,926.37 | $18,197.28 | $178,343.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,766.73 / $7,806.63 / $43,271.62
| Facility | | $6,766.73 | $7,806.63 | $43,271.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,590.87 / $6,590.87 / $42,678.16
| Professional | | $6,590.87 | $6,590.87 | $42,678.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,766.73 / $7,806.63 / $51,118.17
| Facility | | $6,766.73 | $7,806.63 | $51,118.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,184.52 / $4,549.32 / $10,013.81
| Professional | | $3,184.52 | $4,549.32 | $10,013.81 |