- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $11,220.18 / $51,286.14
| Facility | | $10,715.19 | $11,220.18 | $51,286.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,570.88 / $6,918.31 / $7,244.36
| Professional | | $4,570.88 | $6,918.31 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $18,620.87 / $38,904.51
| Facility | | $9,772.37 | $18,620.87 | $38,904.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,912.51 / $10,964.78 / $18,197.01
| Professional | | $8,912.51 | $10,964.78 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $11,481.54 / $29,512.09
| Facility | | $134.90 | $11,481.54 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,760.83 / $6,760.83 / $8,511.38
| Professional | | $6,760.83 | $6,760.83 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $8,511.38 / $17,378.01
| Facility | | $2,187.76 | $8,511.38 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,187.76 / $5,888.44
| Professional | | $1,548.82 | $2,187.76 | $5,888.44 |