- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $12,022.64 / $31,622.78
| Facility | | $5,754.40 | $12,022.64 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,165.95 / $10,964.78
| Professional | | $2,454.71 | $6,165.95 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $10,000.00 / $33,884.42
| Facility | | $5,623.41 | $10,000.00 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $346.74 / $9,120.11
| Professional | | $309.03 | $346.74 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $14,791.08 / $34,673.69
| Facility | | $5,011.87 | $14,791.08 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $10,715.19 / $19,498.45
| Professional | | $4,265.80 | $10,715.19 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $7,762.47 / $9,332.54
| Facility | | $4,677.35 | $7,762.47 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,677.35 / $9,332.54
| Professional | | $3,235.94 | $4,677.35 | $9,332.54 |