- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $9,332.54 / $22,908.68
| Facility | | $5,623.41 | $9,332.54 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,370.32 / $5,888.44 / $15,848.93
| Professional | | $5,370.32 | $5,888.44 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,456.54 / $12,022.64 / $14,791.08
| Professional | | $6,456.54 | $12,022.64 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,025.60 / $8,511.38 / $14,454.40
| Professional | | $6,025.60 | $8,511.38 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,413.10 / $11,481.54
| Facility | | $5,011.87 | $7,413.10 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,964.78 / $11,748.98 / $14,125.38
| Professional | | $10,964.78 | $11,748.98 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $3,890.45 / $6,918.31
| Facility | | $1,174.90 | $3,890.45 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,370.32 / $6,760.83 / $13,182.57
| Professional | | $5,370.32 | $6,760.83 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $51,286.14 / $51,286.14
| Facility | | $56.23 | $51,286.14 | $51,286.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39,810.72 / $39,810.72 / $48,977.88
| Professional | | $39,810.72 | $39,810.72 | $48,977.88 |