- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,221.11 / $11,526.40 / $20,148.70
| Facility | | $9,221.11 | $11,526.40 | $20,148.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,285.12 / $3,723.14 / $5,146.68
| Professional | | $3,285.12 | $3,723.14 | $5,146.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,008.26 / $15,768.58 / $26,420.03
| Facility | | $7,008.26 | $15,768.58 | $26,420.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,299.58 / $2,299.58 / $5,475.20
| Professional | | $2,299.58 | $2,299.58 | $5,475.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,131.81 / $3,665.65 / $16,726.74
| Facility | | $3,131.81 | $3,665.65 | $16,726.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,705.75 / $6,705.75 / $7,939.04
| Professional | | $6,705.75 | $6,705.75 | $7,939.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,161.14 / $5,475.20 / $7,665.28
| Facility | | $4,161.14 | $5,475.20 | $7,665.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,380.16 / $7,665.28 / $10,950.40
| Professional | | $4,380.16 | $7,665.28 | $10,950.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,299.58 / $2,299.58 / $3,285.12
| Professional | | $2,299.58 | $2,299.58 | $3,285.12 |