- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $10,232.93 / $18,620.87
| Facility | | $7,762.47 | $10,232.93 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,762.47 / $10,232.93 / $16,218.10
| Professional | | $7,762.47 | $10,232.93 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $10,964.78 / $38,018.94
| Facility | | $7,943.28 | $10,964.78 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,772.37 / $10,715.19 / $22,387.21
| Professional | | $9,772.37 | $10,715.19 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $12,589.25 / $72,443.60
| Facility | | $12,589.25 | $12,589.25 | $72,443.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,120.11 / $9,120.11 / $28,183.83
| Professional | | $9,120.11 | $9,120.11 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $13,182.57 / $23,988.33
| Facility | | $7,943.28 | $13,182.57 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,079.46 / $9,549.93 / $14,454.40
| Professional | | $7,079.46 | $9,549.93 | $14,454.40 |