- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $6,165.95 / $12,302.69
| Facility | | $4,570.88 | $6,165.95 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $6,165.95 / $10,232.93
| Professional | | $4,466.84 | $6,165.95 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $6,456.54 / $22,908.68
| Facility | | $4,786.30 | $6,456.54 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $6,456.54 / $13,803.84
| Professional | | $6,309.57 | $6,456.54 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $8,128.31 / $46,773.51
| Facility | | $8,128.31 | $8,128.31 | $46,773.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,888.44 / $5,888.44 / $18,197.01
| Professional | | $5,888.44 | $5,888.44 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $7,943.28 / $14,454.40
| Facility | | $4,466.84 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,168.69 / $5,754.40 / $8,709.64
| Professional | | $4,168.69 | $5,754.40 | $8,709.64 |