- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,495.41 / $5,495.41
| Facility | | $4,466.84 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,754.40 / $8,128.31
| Professional | | $5,011.87 | $5,754.40 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,892.96 / $23,442.29 / $28,183.83
| Facility | | $20,892.96 | $23,442.29 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,120.11 / $10,715.19 / $10,964.78
| Professional | | $9,120.11 | $10,715.19 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,918.31 / $8,912.51 / $10,715.19
| Professional | | $6,918.31 | $8,912.51 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $7,413.10 / $12,302.69
| Facility | | $5,248.07 | $7,413.10 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,025.60 / $9,332.54 / $11,748.98
| Professional | | $6,025.60 | $9,332.54 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,943.28 / $9,120.11 / $10,715.19
| Professional | | $7,943.28 | $9,120.11 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,786.30 / $4,786.30 / $11,220.18
| Professional | | $4,786.30 | $4,786.30 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $15,488.17 / $26,302.68
| Facility | | $3,715.35 | $15,488.17 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,495.41 / $8,317.64 / $12,302.69
| Professional | | $5,495.41 | $8,317.64 | $12,302.69 |