- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $11,481.54 / $19,952.62
| Facility | | $9,549.93 | $11,481.54 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,549.93 / $11,481.54 / $19,054.61
| Professional | | $9,549.93 | $11,481.54 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $12,589.25 / $44,668.36
| Facility | | $9,120.11 | $12,589.25 | $44,668.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,748.98 / $12,589.25 / $26,915.35
| Professional | | $11,748.98 | $12,589.25 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.40 / $14,454.40 / $91,201.08
| Facility | | $14,454.40 | $14,454.40 | $91,201.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,715.19 / $10,715.19 / $32,359.37
| Professional | | $10,715.19 | $10,715.19 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $15,488.17 / $27,542.29
| Facility | | $10,000.00 | $15,488.17 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,317.64 / $11,220.18 / $16,982.44
| Professional | | $8,317.64 | $11,220.18 | $16,982.44 |