- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $7,943.28 / $14,454.40
| Facility | | $7,079.46 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,488.17 / $15,488.17 / $15,488.17
| Professional | | $15,488.17 | $15,488.17 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $13,803.84 / $26,915.35
| Facility | | $10,715.19 | $13,803.84 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,982.44 / $19,054.61 / $19,952.62
| Professional | | $16,982.44 | $19,054.61 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,000.00 / $10,000.00 / $10,000.00
| Professional | | $10,000.00 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $15,488.17 / $30,199.52
| Facility | | $9,549.93 | $15,488.17 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $13,489.63 / $24,547.09
| Facility | | $9,120.11 | $13,489.63 | $24,547.09 |