- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $15,488.17 / $15,488.17
| Facility | | $8,912.51 | $15,488.17 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,413.10 / $8,912.51 / $14,791.08
| Professional | | $7,413.10 | $8,912.51 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,197.01 / $20,417.38 / $38,904.51
| Facility | | $18,197.01 | $20,417.38 | $38,904.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,623.41 / $5,623.41 / $12,589.25
| Professional | | $5,623.41 | $5,623.41 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $9,772.37 / $9,772.37
| Facility | | $9,772.37 | $9,772.37 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,317.64 / $8,317.64 / $10,000.00
| Professional | | $8,317.64 | $8,317.64 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,715.19 / $18,197.01 / $28,183.83
| Professional | | $10,715.19 | $18,197.01 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,378.01 / $18,197.01 / $18,197.01
| Professional | | $17,378.01 | $18,197.01 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.59 / $10,471.29 / $12,302.69
| Facility | | $12.59 | $10,471.29 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,244.36 / $7,762.47 / $12,302.69
| Professional | | $7,244.36 | $7,762.47 | $12,302.69 |