- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $6,309.57 / $13,803.84
| Facility | | $5,248.07 | $6,309.57 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,128.61 / $6,309.57 / $10,471.29
| Professional | | $5,128.61 | $6,309.57 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $7,413.10 / $24,547.09
| Facility | | $5,495.41 | $7,413.10 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $7,244.36 / $15,135.61
| Professional | | $6,309.57 | $7,244.36 | $15,135.61 |
- 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
- $5,011.87 / $8,912.51 / $16,218.10
| Facility | | $5,011.87 | $8,912.51 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $6,025.60 / $9,772.37
| Professional | | $4,677.35 | $6,025.60 | $9,772.37 |