- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,424.65 / $6,591.69 / $8,117.45
| Facility | | $6,424.65 | $6,591.69 | $8,117.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,292.50 / $6,663.06 / $8,809.35
| Professional | | $5,292.50 | $6,663.06 | $8,809.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,093.94 / $13,827.39 / $26,266.14
| Facility | | $11,093.94 | $13,827.39 | $26,266.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,763.44 / $6,777.58 / $10,298.25
| Professional | | $6,763.44 | $6,777.58 | $10,298.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,732.85 / $8,732.85 / $8,732.85
| Facility | | $8,732.85 | $8,732.85 | $8,732.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,374.98 / $8,545.18 / $8,994.84
| Professional | | $6,374.98 | $8,545.18 | $8,994.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,544.86 / $5,544.86 / $5,544.86
| Facility | | $5,544.86 | $5,544.86 | $5,544.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,612.20 / $6,350.32 / $9,014.00
| Professional | | $4,612.20 | $6,350.32 | $9,014.00 |