- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $26,302.68 / $34,673.69
| Facility | | $4,897.79 | $26,302.68 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,897.79 / $5,370.32
| Professional | | $2,951.21 | $4,897.79 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $4,786.30 / $15,135.61
| Facility | | $4,677.35 | $4,786.30 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,606.93 / $6,606.93 / $6,606.93
| Professional | | $6,606.93 | $6,606.93 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $5,495.41 / $25,703.96
| Facility | | $4,677.35 | $5,495.41 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $4,677.35 / $5,495.41
| Professional | | $4,677.35 | $4,677.35 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $3,801.89 / $15,848.93
| Professional | | $3,801.89 | $3,801.89 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $4,786.30 / $8,128.31
| Professional | | $4,365.16 | $4,786.30 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $3,311.31
| Professional | | $2,290.87 | $2,290.87 | $3,311.31 |