- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $9,772.37 / $18,620.87
| Facility | | $7,585.78 | $9,772.37 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,413.10 / $10,000.00 / $15,135.61
| Professional | | $7,413.10 | $10,000.00 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $10,471.29 / $36,307.81
| Facility | | $7,762.47 | $10,471.29 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,120.11 / $10,232.93 / $21,379.62
| Professional | | $9,120.11 | $10,232.93 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $11,748.98 / $67,608.30
| Facility | | $11,748.98 | $11,748.98 | $67,608.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,511.38 / $8,511.38 / $26,302.68
| Professional | | $8,511.38 | $8,511.38 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $12,882.50 / $22,908.68
| Facility | | $7,585.78 | $12,882.50 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,760.83 / $8,912.51 / $14,125.38
| Professional | | $6,760.83 | $8,912.51 | $14,125.38 |