- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,529.60 / $6,700.03 / $6,914.58
| Facility | | $4,529.60 | $6,700.03 | $6,914.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,529.60 / $5,347.27 / $9,436.66
| Professional | | $4,529.60 | $5,347.27 | $9,436.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,914.37 / $10,410.10 / $45,764.78
| Facility | | $9,914.37 | $10,410.10 | $45,764.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,484.40 / $5,623.53 / $8,024.12
| Professional | | $5,484.40 | $5,623.53 | $8,024.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,261.93 / $7,261.93 / $7,261.93
| Facility | | $7,261.93 | $7,261.93 | $7,261.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,301.21 / $5,301.21 / $5,301.21
| Professional | | $5,301.21 | $5,301.21 | $5,301.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,609.72 / $8,025.65 / $48,028.87
| Facility | | $4,609.72 | $8,025.65 | $48,028.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,844.58 / $5,358.35 / $9,544.04
| Professional | | $3,844.58 | $5,358.35 | $9,544.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,774.66 / $5,358.35 / $7,286.95
| Professional | | $3,774.66 | $5,358.35 | $7,286.95 |