- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $6,025.60 / $39,810.72
| Facility | | $4,073.80 | $6,025.60 | $39,810.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,981.07 / $5,888.44 / $10,964.78
| Professional | | $3,981.07 | $5,888.44 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $10,715.19 / $26,915.35
| Facility | | $8,511.38 | $10,715.19 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,332.54 / $11,220.18 / $17,378.01
| Professional | | $9,332.54 | $11,220.18 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $7,585.78 / $38,018.94
| Facility | | $7,585.78 | $7,585.78 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,456.54 / $6,456.54 / $12,302.69
| Professional | | $6,456.54 | $6,456.54 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $8,317.64 / $14,125.38
| Facility | | $5,495.41 | $8,317.64 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,073.80 / $6,760.83 / $14,125.38
| Professional | | $4,073.80 | $6,760.83 | $14,125.38 |