- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $22,387.21 / $41,686.94
| Facility | | $16,982.44 | $22,387.21 | $41,686.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,623.41 / $6,309.57 / $8,511.38
| Professional | | $5,623.41 | $6,309.57 | $8,511.38 |
- 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
- $12,302.69 / $13,182.57 / $13,803.84
| Professional | | $12,302.69 | $13,182.57 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,232.93 / $16,218.10 / $20,417.38
| Professional | | $10,232.93 | $16,218.10 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $5,623.41 / $39,810.72
| Facility | | $3,019.95 | $5,623.41 | $39,810.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,187.76 / $10,715.19
| Professional | | $1,548.82 | $2,187.76 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,232.93 / $10,232.93 / $10,232.93
| Professional | | $10,232.93 | $10,232.93 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $5,495.41 / $14,791.08
| Facility | | $3,548.13 | $5,495.41 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,187.76 / $7,244.36
| Professional | | $2,089.30 | $2,187.76 | $7,244.36 |