- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $6,918.31 / $7,762.47
| Facility | | $3,890.45 | $6,918.31 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,265.80 / $10,232.93
| Professional | | $3,630.78 | $4,265.80 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56,234.13 / $69,183.10 / $81,283.05
| Facility | | $56,234.13 | $69,183.10 | $81,283.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $5,754.40 / $8,128.31
| Professional | | $2,818.38 | $5,754.40 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $6,165.95
| Professional | | $32.36 | $33.11 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $5,128.61 / $8,709.64
| Facility | | $4,073.80 | $5,128.61 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $5,248.07 / $8,128.31
| Professional | | $2,818.38 | $5,248.07 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $5,128.61 / $19,498.45
| Facility | | $3,090.30 | $5,128.61 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,073.80 / $5,370.32 / $8,709.64
| Professional | | $4,073.80 | $5,370.32 | $8,709.64 |