- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,912.51 / $20,892.96
| Facility | | $5,011.87 | $8,912.51 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $7,413.10 / $33,113.11
| Professional | | $1,995.26 | $7,413.10 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $6,760.83 / $24,547.09
| Facility | | $1,778.28 | $6,760.83 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $851.14 / $6,456.54
| Professional | | $676.08 | $851.14 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $9,549.93 / $21,379.62
| Facility | | $3,235.94 | $9,549.93 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,165.95 / $12,302.69
| Professional | | $2,511.89 | $6,165.95 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $5,011.87 / $6,025.60
| Facility | | $3,019.95 | $5,011.87 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,019.95 / $6,025.60
| Professional | | $2,089.30 | $3,019.95 | $6,025.60 |