- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $8,912.51 / $40,738.03
| Facility | | $8,709.64 | $8,912.51 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $5,495.41 / $6,760.83
| Professional | | $3,630.78 | $5,495.41 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $14,791.08 / $14,791.08
| Facility | | $6,606.93 | $14,791.08 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,079.46 / $8,912.51 / $14,791.08
| Professional | | $7,079.46 | $8,912.51 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $11,481.54 / $29,512.09
| Facility | | $134.90 | $11,481.54 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $4,677.35 / $4,677.35
| Professional | | $4,677.35 | $4,677.35 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $6,760.83 / $13,803.84
| Facility | | $3,162.28 | $6,760.83 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $4,073.80 / $7,079.46
| Professional | | $2,691.53 | $4,073.80 | $7,079.46 |