- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $24,547.09 / $38,904.51
| Facility | | $13,803.84 | $24,547.09 | $38,904.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $2,951.21 / $3,090.30
| Professional | | $478.63 | $2,951.21 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $8,709.64 / $8,709.64
| Facility | | $8,709.64 | $8,709.64 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $22,908.68
| Facility | | $3,162.28 | $3,162.28 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $9,549.93 / $10,232.93
| Professional | | $3,162.28 | $9,549.93 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $11,748.98 / $12,589.25
| Facility | | $3,162.28 | $11,748.98 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,079.46 / $7,079.46 / $7,079.46
| Professional | | $7,079.46 | $7,079.46 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $8,709.64 / $15,135.61
| Facility | | $2,511.89 | $8,709.64 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $6,309.57 / $9,549.93
| Professional | | $1,905.46 | $6,309.57 | $9,549.93 |