- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $21,877.62 / $44,668.36
| Facility | | $11,748.98 | $21,877.62 | $44,668.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $9,772.37 / $14,454.40
| Professional | | $1,905.46 | $9,772.37 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,135.61 / $15,135.61 / $15,135.61
| Professional | | $15,135.61 | $15,135.61 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $10,964.78 / $24,547.09
| Facility | | $1,230.27 | $10,964.78 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,772.37 / $13,803.84 / $17,378.01
| Professional | | $9,772.37 | $13,803.84 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $20,892.96
| Facility | | $1,202.26 | $1,202.26 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,244.36 / $29,512.09
| Professional | | $5,011.87 | $7,244.36 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $12,022.64 / $12,589.25
| Facility | | $5,011.87 | $12,022.64 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,244.36 / $12,022.64
| Professional | | $5,011.87 | $7,244.36 | $12,022.64 |