- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $11,220.18 / $19,498.45
| Facility | | $8,511.38 | $11,220.18 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,511.38 / $11,220.18 / $17,782.79
| Professional | | $8,511.38 | $11,220.18 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $12,022.64 / $43,651.58
| Facility | | $8,709.64 | $12,022.64 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,715.19 / $11,748.98 / $24,547.09
| Professional | | $10,715.19 | $11,748.98 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $13,803.84 / $81,283.05
| Facility | | $13,803.84 | $13,803.84 | $81,283.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,000.00 / $10,000.00 / $30,902.95
| Professional | | $10,000.00 | $10,000.00 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $14,791.08 / $26,302.68
| Facility | | $9,549.93 | $14,791.08 | $26,302.68 |
- 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 |