- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $23,988.33 / $57,543.99
| Facility | | $16,982.44 | $23,988.33 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,244.36 / $8,317.64 / $9,120.11
| Professional | | $7,244.36 | $8,317.64 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $22,908.68 / $44,668.36
| Facility | | $18,620.87 | $22,908.68 | $44,668.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,079.46 / $7,079.46 / $7,585.78
| Professional | | $7,079.46 | $7,079.46 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $10,232.93 / $10,232.93
| Facility | | $8,317.64 | $10,232.93 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $4,570.88 / $5,370.32
| Facility | | $2,754.23 | $4,570.88 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $3,388.44 / $5,623.41
| Professional | | $3,388.44 | $3,388.44 | $5,623.41 |