- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $15,848.93 / $31,622.78
| Facility | | $8,317.64 | $15,848.93 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,623.41 / $6,918.31 / $8,511.38
| Professional | | $5,623.41 | $6,918.31 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,715.19 / $10,715.19 / $10,715.19
| Professional | | $10,715.19 | $10,715.19 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $15,488.17 / $17,378.01
| Facility | | $7,762.47 | $15,488.17 | $17,378.01 |
- 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
- $3,548.13 / $5,128.61 / $42,657.95
| Professional | | $3,548.13 | $5,128.61 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $8,511.38 / $10,232.93
| Facility | | $3,548.13 | $8,511.38 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $5,128.61 / $10,964.78
| Professional | | $3,548.13 | $5,128.61 | $10,964.78 |