- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $10,471.29 / $36,307.81
| Facility | | $1,479.11 | $10,471.29 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $5,370.32 / $6,606.93
| Professional | | $4,677.35 | $5,370.32 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $5,623.41 / $16,218.10
| Facility | | $3,019.95 | $5,623.41 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $4,073.80
| Professional | | $426.58 | $426.58 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $7,943.28 / $10,964.78
| Facility | | $4,365.16 | $7,943.28 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,762.47 / $8,128.31 / $9,772.37
| Professional | | $7,762.47 | $8,128.31 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,760.83 / $6,760.83 / $10,964.78
| Professional | | $6,760.83 | $6,760.83 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,760.83 / $6,760.83 / $6,760.83
| Professional | | $6,760.83 | $6,760.83 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $4,677.35 / $4,677.35
| Facility | | $4,677.35 | $4,677.35 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $2,818.38 / $7,079.46
| Professional | | $2,818.38 | $2,818.38 | $7,079.46 |