- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $13,182.57 / $28,183.83
| Facility | | $9,772.37 | $13,182.57 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,623.41 / $6,918.31 / $8,128.31
| Professional | | $5,623.41 | $6,918.31 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $8,511.38 / $25,703.96
| Facility | | $8,511.38 | $8,511.38 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,548.82 / $3,235.94
| Professional | | $1,318.26 | $1,548.82 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $123,026.88 / $186,208.71
| Facility | | $8,317.64 | $123,026.88 | $186,208.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $33,113.11
| Facility | | $5,495.41 | $5,495.41 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,772.37 / $10,471.29 / $25,703.96
| Professional | | $9,772.37 | $10,471.29 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $8,511.38 / $8,511.38
| Facility | | $8,511.38 | $8,511.38 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $5,128.61 / $8,511.38
| Professional | | $3,548.13 | $5,128.61 | $8,511.38 |