- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $14,791.08 / $38,904.51
| Facility | | $7,079.46 | $14,791.08 | $38,904.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,623.41 / $6,918.31 / $9,772.37
| Professional | | $5,623.41 | $6,918.31 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $14,454.40 / $40,738.03
| Facility | | $6,165.95 | $14,454.40 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,621.81 / $9,120.11
| Professional | | $1,548.82 | $1,621.81 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $13,489.63 / $34,673.69
| Facility | | $5,495.41 | $13,489.63 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,772.37 / $12,302.69 / $23,442.29
| Professional | | $9,772.37 | $12,302.69 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $8,511.38 / $10,232.93
| Facility | | $5,128.61 | $8,511.38 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $5,128.61 / $10,232.93
| Professional | | $3,548.13 | $5,128.61 | $10,232.93 |