- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $10,964.78 / $18,620.87
| Facility | | $8,912.51 | $10,964.78 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,912.51 / $10,964.78 / $17,782.79
| Professional | | $8,912.51 | $10,964.78 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $11,748.98 / $41,686.94
| Facility | | $8,511.38 | $11,748.98 | $41,686.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,220.18 / $12,022.64 / $23,988.33
| Professional | | $11,220.18 | $12,022.64 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $12,882.50 / $87,096.36
| Facility | | $12,882.50 | $12,882.50 | $87,096.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,332.54 / $9,332.54 / $30,902.95
| Professional | | $9,332.54 | $9,332.54 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $14,454.40 / $25,703.96
| Facility | | $9,332.54 | $14,454.40 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,762.47 / $10,471.29 / $16,218.10
| Professional | | $7,762.47 | $10,471.29 | $16,218.10 |