- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,118.26 / $5,366.54 / $8,040.05
| Facility | | $5,118.26 | $5,366.54 | $8,040.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,310.35 / $5,117.68 / $7,350.86
| Professional | | $4,310.35 | $5,117.68 | $7,350.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,775.93 / $10,264.73 / $19,747.62
| Facility | | $9,775.93 | $10,264.73 | $19,747.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,713.73 / $7,950.24 / $9,284.00
| Professional | | $5,713.73 | $7,950.24 | $9,284.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,957.05 / $7,957.05 / $7,957.05
| Facility | | $7,957.05 | $7,957.05 | $7,957.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,763.49 / $6,763.49 / $8,195.76
| Professional | | $6,763.49 | $6,763.49 | $8,195.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,147.53 / $11,938.27 / $11,938.27
| Facility | | $10,147.53 | $11,938.27 | $11,938.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,778.10 / $4,938.32 / $7,101.12
| Professional | | $3,778.10 | $4,938.32 | $7,101.12 |