- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,220.62 / $12,597.10 / $16,726.30
| Facility | | $8,220.62 | $12,597.10 | $16,726.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,666.54 / $2,666.54 / $18,572.59
| Professional | | $2,666.54 | $2,666.54 | $18,572.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,464.21 / $7,582.20 / $18,197.28
| Facility | | $2,464.21 | $7,582.20 | $18,197.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $846.27 / $846.27 / $4,587.22
| Professional | | $846.27 | $846.27 | $4,587.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,340.11 / $7,294.08 / $27,451.36
| Facility | | $3,340.11 | $7,294.08 | $27,451.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,235.41 / $9,235.41 / $11,065.06
| Professional | | $9,235.41 | $9,235.41 | $11,065.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,895.55 / $7,582.20 / $7,961.31
| Professional | | $1,895.55 | $7,582.20 | $7,961.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,184.52 / $3,184.52 / $7,582.20
| Professional | | $3,184.52 | $3,184.52 | $7,582.20 |