- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $16,982.44 / $36,307.81
| Facility | | $4,897.79 | $16,982.44 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $5,888.44 / $7,762.47
| Professional | | $2,454.71 | $5,888.44 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $22,387.21 / $37,153.52
| Facility | | $9,772.37 | $22,387.21 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $7,762.47
| Professional | | $3,235.94 | $3,235.94 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $5,011.87 / $23,988.33
| Facility | | $4,168.69 | $5,011.87 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,073.80 / $9,549.93 / $11,220.18
| Professional | | $4,073.80 | $9,549.93 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,964.78 / $10,964.78 / $11,220.18
| Professional | | $10,964.78 | $10,964.78 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,495.41 / $7,762.47 / $7,762.47
| Professional | | $5,495.41 | $7,762.47 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $4,677.35
| Professional | | $3,235.94 | $3,235.94 | $4,677.35 |