- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $16,982.44 / $43,651.58
| Facility | | $6,456.54 | $16,982.44 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,570.88 / $6,309.57 / $7,244.36
| Professional | | $4,570.88 | $6,309.57 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $13,182.57 / $19,498.45
| Facility | | $4,073.80 | $13,182.57 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,128.31 / $8,317.64 / $16,218.10
| Professional | | $8,128.31 | $8,317.64 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $6,456.54 / $23,442.29
| Facility | | $5,011.87 | $6,456.54 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $8,511.38 / $15,488.17
| Facility | | $5,623.41 | $8,511.38 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,548.82 / $41,686.94
| Professional | | $1,548.82 | $1,548.82 | $41,686.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $8,511.38 / $10,232.93
| Facility | | $4,365.16 | $8,511.38 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,548.82 / $3,548.13
| Professional | | $1,548.82 | $1,548.82 | $3,548.13 |