- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,890.11 / $52,785.33 / $62,100.39
| Facility | | $8,890.11 | $52,785.33 | $62,100.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,024.67 / $9,812.82 / $31,065.37
| Facility | | $8,024.67 | $9,812.82 | $31,065.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $727.13 / $2,663.76
| Professional | | $60.00 | $727.13 | $2,663.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,019.82 / $15,952.23 / $26,319.12
| Facility | | $12,019.82 | $15,952.23 | $26,319.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.18 / $2,260.94 / $2,403.34
| Professional | | $1,659.18 | $2,260.94 | $2,403.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,633.54 / $2,346.53 / $3,348.87
| Professional | | $1,633.54 | $2,346.53 | $3,348.87 |