- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $12,302.69 / $43,651.58
| Facility | | $8,912.51 | $12,302.69 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,128.61 / $7,244.36 / $10,715.19
| Professional | | $5,128.61 | $7,244.36 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $16,595.87 / $26,302.68
| Facility | | $9,120.11 | $16,595.87 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $794.33 / $794.33
| Professional | | $724.44 | $794.33 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $8,511.38 / $8,511.38
| Facility | | $8,511.38 | $8,511.38 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $9,549.93 / $64,565.42
| Facility | | $5,495.41 | $9,549.93 | $64,565.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,715.35 / $8,511.38
| Facility | | $2,187.76 | $3,715.35 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,862.09 / $5,495.41
| Professional | | $1,548.82 | $1,862.09 | $5,495.41 |