- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $14,791.08 / $38,904.51
| Facility | | $7,585.78 | $14,791.08 | $38,904.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,128.61 / $6,309.57 / $8,912.51
| Professional | | $5,128.61 | $6,309.57 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $14,454.40 / $42,657.95
| Facility | | $6,456.54 | $14,454.40 | $42,657.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $281.84 / $10,232.93
| Professional | | $177.83 | $281.84 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $16,218.10 / $37,153.52
| Facility | | $5,495.41 | $16,218.10 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,772.37 / $12,302.69 / $23,442.29
| Professional | | $9,772.37 | $12,302.69 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $8,511.38 / $10,232.93
| Facility | | $3,311.31 | $8,511.38 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,187.76 / $7,079.46
| Professional | | $1,548.82 | $2,187.76 | $7,079.46 |