- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $10,471.29 / $19,952.62
| Facility | | $7,585.78 | $10,471.29 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $16,218.10 / $16,218.10
| Professional | | $2,398.83 | $16,218.10 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,488.17 / $20,417.38 / $39,810.72
| Facility | | $15,488.17 | $20,417.38 | $39,810.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,332.54 / $10,232.93 / $10,715.19
| Professional | | $9,332.54 | $10,232.93 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $14,125.38 / $19,054.61
| Facility | | $9,549.93 | $14,125.38 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $10,000.00 / $16,218.10
| Facility | | $9,120.11 | $10,000.00 | $16,218.10 |