- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $15,848.93 / $16,595.87
| Facility | | $6,309.57 | $15,848.93 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $7,943.28 / $9,772.37
| Professional | | $7.08 | $7,943.28 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $5,011.87 / $5,011.87
| Professional | | $2,630.27 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $6,025.60 / $14,454.40
| Facility | | $2,238.72 | $6,025.60 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,162.28 / $6,025.60
| Professional | | $2,238.72 | $3,162.28 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,988.33 / $23,988.33 / $23,988.33
| Facility | | $23,988.33 | $23,988.33 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25,118.86 / $38,018.94 / $38,018.94
| Professional | | $25,118.86 | $38,018.94 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,011.87 / $5,011.87
| Facility | | $1,819.70 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,019.95 / $5,011.87
| Professional | | $2,089.30 | $3,019.95 | $5,011.87 |