- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $12,302.69 / $32,359.37
| Facility | | $6,025.60 | $12,302.69 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,786.30 / $5,888.44 / $10,715.19
| Professional | | $4,786.30 | $5,888.44 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $9,549.93 / $33,113.11
| Facility | | $7,244.36 | $9,549.93 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,388.44 / $11,748.98
| Professional | | $2,884.03 | $3,388.44 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $13,803.84 / $31,622.78
| Facility | | $4,677.35 | $13,803.84 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $8,317.64 / $17,378.01
| Professional | | $3,388.44 | $8,317.64 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $7,244.36 / $8,709.64
| Facility | | $4,365.16 | $7,244.36 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $4,365.16 / $8,709.64
| Professional | | $3,019.95 | $4,365.16 | $8,709.64 |