- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $19,498.45 / $54,954.09
| Facility | | $10,964.78 | $19,498.45 | $54,954.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $6,918.31
| Professional | | $2,454.71 | $2,454.71 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $15,135.61 / $44,668.36
| Facility | | $13,182.57 | $15,135.61 | $44,668.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $5,011.87 / $7,413.10
| Professional | | $309.03 | $5,011.87 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $24,547.09 / $33,884.42
| Facility | | $12,589.25 | $24,547.09 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,073.80 / $8,128.31 / $32,359.37
| Professional | | $4,073.80 | $8,128.31 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,762.47 / $7,762.47 / $14,791.08
| Professional | | $7,762.47 | $7,762.47 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $4,677.35 / $7,762.47
| Professional | | $4,677.35 | $4,677.35 | $7,762.47 |