- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,079.46 / $10,715.19
| Facility | | $4,570.88 | $7,079.46 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,248.07 / $5,888.44 / $15,488.17
| Professional | | $5,248.07 | $5,888.44 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $16,982.44 / $18,620.87
| Facility | | $8,709.64 | $16,982.44 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,370.32 / $11,220.18 / $14,454.40
| Professional | | $5,370.32 | $11,220.18 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,606.93 / $9,549.93 / $15,848.93
| Professional | | $6,606.93 | $9,549.93 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,332.54 / $9,332.54 / $10,715.19
| Professional | | $9,332.54 | $9,332.54 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $6,165.95 / $15,135.61
| Facility | | $3,311.31 | $6,165.95 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,623.41 / $7,244.36 / $13,803.84
| Professional | | $5,623.41 | $7,244.36 | $13,803.84 |