- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $17,378.01 / $31,622.78
| Facility | | $8,128.31 | $17,378.01 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,888.44 / $6,918.31 / $8,511.38
| Professional | | $5,888.44 | $6,918.31 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,471.29 / $10,471.29 / $10,471.29
| Professional | | $10,471.29 | $10,471.29 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $15,488.17 / $19,054.61
| Facility | | $7,585.78 | $15,488.17 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $8,511.38 / $11,481.54
| Facility | | $6,760.83 | $8,511.38 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,187.76 / $41,686.94
| Professional | | $1,548.82 | $2,187.76 | $41,686.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $8,511.38 / $10,232.93
| Facility | | $2,187.76 | $8,511.38 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,187.76 / $5,495.41
| Professional | | $1,548.82 | $2,187.76 | $5,495.41 |