- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $17,782.79 / $33,113.11
| Facility | | $13,489.63 | $17,782.79 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,011.87 / $6,309.57
| Professional | | $4,466.84 | $5,011.87 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $295.12 / $575.44
| Facility | | $223.87 | $295.12 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,772.37 / $10,471.29 / $10,964.78
| Professional | | $9,772.37 | $10,471.29 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,128.31 / $12,882.50 / $16,218.10
| Professional | | $8,128.31 | $12,882.50 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $8,511.38 / $32,359.37
| Facility | | $4,073.80 | $8,511.38 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $4,073.80 / $19,498.45
| Professional | | $2,818.38 | $4,073.80 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,128.31 / $8,128.31 / $8,128.31
| Professional | | $8,128.31 | $8,128.31 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $6,456.54 / $13,489.63
| Facility | | $2,818.38 | $6,456.54 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $4,073.80 / $6,760.83
| Professional | | $3,801.89 | $4,073.80 | $6,760.83 |