- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $7,762.47 / $16,218.10
| Facility | | $6,165.95 | $7,762.47 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,165.95 / $7,762.47 / $12,302.69
| Professional | | $6,165.95 | $7,762.47 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $8,912.51 / $29,512.09
| Facility | | $6,606.93 | $8,912.51 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,585.78 / $8,511.38 / $17,782.79
| Professional | | $7,585.78 | $8,511.38 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $9,332.54 / $54,954.09
| Facility | | $9,332.54 | $9,332.54 | $54,954.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,918.31 / $6,918.31 / $20,892.96
| Professional | | $6,918.31 | $6,918.31 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $10,715.19 / $19,498.45
| Facility | | $6,025.60 | $10,715.19 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,623.41 / $7,244.36 / $11,748.98
| Professional | | $5,623.41 | $7,244.36 | $11,748.98 |