- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $6,918.31 / $14,125.38
| Facility | | $5,623.41 | $6,918.31 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,495.41 / $6,918.31 / $11,748.98
| Professional | | $5,495.41 | $6,918.31 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $7,585.78 / $26,302.68
| Facility | | $5,623.41 | $7,585.78 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,079.46 / $7,413.10 / $16,218.10
| Professional | | $7,079.46 | $7,413.10 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $9,120.11 / $52,480.75
| Facility | | $9,120.11 | $9,120.11 | $52,480.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,606.93 / $6,606.93 / $20,417.38
| Professional | | $6,606.93 | $6,606.93 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $9,120.11 / $16,595.87
| Facility | | $5,128.61 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,897.79 / $6,456.54 / $10,232.93
| Professional | | $4,897.79 | $6,456.54 | $10,232.93 |