- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $22,908.68 / $35,481.34
| Facility | | $12,589.25 | $22,908.68 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,754.23 / $9,772.37
| Professional | | $2,344.23 | $2,754.23 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $8,128.31 / $8,128.31
| Facility | | $8,128.31 | $8,128.31 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $2,951.21 / $14,125.38
| Facility | | $2,951.21 | $2,951.21 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $2,951.21 / $9,332.54
| Professional | | $2,951.21 | $2,951.21 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $10,715.19 / $11,748.98
| Facility | | $2,951.21 | $10,715.19 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,606.93 / $6,606.93 / $6,606.93
| Professional | | $6,606.93 | $6,606.93 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $8,128.31 / $14,125.38
| Facility | | $2,344.23 | $8,128.31 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $5,888.44 / $8,709.64
| Professional | | $1,737.80 | $5,888.44 | $8,709.64 |