- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $6,760.83 / $20,417.38
| Facility | | $5,370.32 | $6,760.83 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $5,248.07 / $8,511.38
| Professional | | $4,677.35 | $5,248.07 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $4,365.16 / $18,197.01
| Facility | | $4,365.16 | $4,365.16 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,128.31 / $8,128.31 / $9,772.37
| Professional | | $8,128.31 | $8,128.31 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $6,760.83 / $11,748.98
| Facility | | $4,786.30 | $6,760.83 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $2,818.38 / $8,912.51
| Professional | | $2,818.38 | $2,818.38 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $6,760.83 / $8,128.31
| Facility | | $2,818.38 | $6,760.83 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $2,818.38 / $4,466.84
| Professional | | $2,818.38 | $2,818.38 | $4,466.84 |