- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $26,302.68 / $42,657.95
| Facility | | $7,585.78 | $26,302.68 | $42,657.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $5,754.40 / $7,413.10
| Professional | | $2,691.53 | $5,754.40 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $21,877.62 / $36,307.81
| Facility | | $9,772.37 | $21,877.62 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $7,585.78
| Professional | | $3,162.28 | $3,162.28 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $4,897.79 / $22,908.68
| Facility | | $4,073.80 | $4,897.79 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,332.54 / $9,332.54 / $10,964.78
| Professional | | $9,332.54 | $9,332.54 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,715.19 / $10,715.19 / $10,715.19
| Professional | | $10,715.19 | $10,715.19 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,248.07 / $7,585.78 / $7,585.78
| Professional | | $5,248.07 | $7,585.78 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $4,570.88
| Professional | | $3,162.28 | $3,162.28 | $4,570.88 |