- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $12,302.69 / $28,840.32
| Facility | | $5,888.44 | $12,302.69 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,481.54 / $11,481.54 / $15,488.17
| Professional | | $11,481.54 | $11,481.54 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $37,153.52 / $89,125.09
| Facility | | $1,288.25 | $37,153.52 | $89,125.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $19,054.61 / $47,863.01
| Professional | | $1,584.89 | $19,054.61 | $47,863.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $14,791.08 / $25,703.96
| Facility | | $4,897.79 | $14,791.08 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $10,715.19 / $25,118.86
| Professional | | $794.33 | $10,715.19 | $25,118.86 |