- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $16,982.44 / $43,651.58
| Facility | | $6,606.93 | $16,982.44 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,248.07 / $6,918.31 / $10,232.93
| Professional | | $5,248.07 | $6,918.31 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $7,762.47 / $11,481.54
| Facility | | $2,398.83 | $7,762.47 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $3,715.35 / $7,244.36
| Professional | | $3,630.78 | $3,715.35 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $5,754.40 / $8,317.64
| Facility | | $4,786.30 | $5,754.40 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $8,511.38 / $16,595.87
| Facility | | $5,754.40 | $8,511.38 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $42,657.95
| Professional | | $3,548.13 | $3,548.13 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $8,511.38 / $10,232.93
| Facility | | $7,585.78 | $8,511.38 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $5,128.61
| Professional | | $3,548.13 | $3,548.13 | $5,128.61 |