- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $9,549.93 / $43,651.58
| Facility | | $9,120.11 | $9,549.93 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $5,888.44 / $9,549.93
| Professional | | $4,265.80 | $5,888.44 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $15,848.93 / $33,113.11
| Facility | | $8,317.64 | $15,848.93 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,168.69 / $7,079.46 / $13,182.57
| Professional | | $4,168.69 | $7,079.46 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,585.78 / $13,803.84
| Professional | | $5,011.87 | $7,585.78 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $11,481.54 / $30,199.52
| Facility | | $134.90 | $11,481.54 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,754.40 / $5,754.40 / $7,244.36
| Professional | | $5,754.40 | $5,754.40 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $7,244.36 / $14,791.08
| Facility | | $3,388.44 | $7,244.36 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,365.16 / $7,585.78
| Professional | | $2,884.03 | $4,365.16 | $7,585.78 |