- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,618.60 / $6,831.68 / $7,050.47
| Facility | | $4,618.60 | $6,831.68 | $7,050.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,618.60 / $5,322.14 / $9,622.09
| Professional | | $4,618.60 | $5,322.14 | $9,622.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,109.19 / $10,614.65 / $46,664.02
| Facility | | $10,109.19 | $10,614.65 | $46,664.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,458.63 / $6,543.68 / $8,221.28
| Professional | | $5,458.63 | $6,543.68 | $8,221.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,503.37 / $7,503.37 / $7,503.37
| Facility | | $7,503.37 | $7,503.37 | $7,503.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,477.46 / $5,477.46 / $7,998.97
| Professional | | $5,477.46 | $5,477.46 | $7,998.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,700.31 / $8,150.19 / $48,813.24
| Facility | | $4,700.31 | $8,150.19 | $48,813.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,916.55 / $5,463.65 / $9,499.20
| Professional | | $3,916.55 | $5,463.65 | $9,499.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,848.84 / $5,081.68 / $7,242.34
| Professional | | $3,848.84 | $5,081.68 | $7,242.34 |