- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $14,125.38 / $16,595.87
| Facility | | $8,317.64 | $14,125.38 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,623.41 / $7,244.36 / $9,772.37
| Professional | | $5,623.41 | $7,244.36 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,786.30 / $13,489.63
| Professional | | $1,548.82 | $4,786.30 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $16,595.87 / $20,417.38
| Facility | | $10,964.78 | $16,595.87 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,772.37 / $9,772.37 / $9,772.37
| Professional | | $9,772.37 | $9,772.37 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $10,232.93 / $40,738.03
| Facility | | $7,413.10 | $10,232.93 | $40,738.03 |
- 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 / $9,332.54
| Professional | | $3,548.13 | $5,128.61 | $9,332.54 |