- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $14,125.38 / $45,708.82
| Facility | | $10,232.93 | $14,125.38 | $45,708.82 |
- 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
- $8,709.64 / $8,709.64 / $8,709.64
| Facility | | $8,709.64 | $8,709.64 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,709.64 / $8,709.64 / $8,709.64
| Professional | | $8,709.64 | $8,709.64 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $8,709.64 / $8,709.64
| Facility | | $8,709.64 | $8,709.64 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,709.64 / $8,709.64 / $8,709.64
| Professional | | $8,709.64 | $8,709.64 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $10,715.19 / $12,302.69
| Facility | | $8,317.64 | $10,715.19 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,585.78 / $8,709.64 / $9,549.93
| Professional | | $7,585.78 | $8,709.64 | $9,549.93 |