- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $12,882.50 / $24,547.09
| Facility | | $8,128.31 | $12,882.50 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,128.31 / $8,511.38 / $10,232.93
| Professional | | $8,128.31 | $8,511.38 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $10,715.19 / $22,387.21
| Facility | | $512.86 | $10,715.19 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $8,128.31 / $9,549.93
| Professional | | $426.58 | $8,128.31 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $8,709.64 / $11,220.18
| Facility | | $1,513.56 | $8,709.64 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $8,709.64 / $8,709.64
| Professional | | $562.34 | $8,709.64 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $16,595.87 / $28,183.83
| Facility | | $10,232.93 | $16,595.87 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,511.38 / $8,709.64 / $9,772.37
| Professional | | $8,511.38 | $8,709.64 | $9,772.37 |