- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $6,918.31 / $10,471.29
| Facility | | $4,570.88 | $6,918.31 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $4,466.84 / $10,471.29
| Professional | | $3,467.37 | $4,466.84 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $21,877.62 / $26,915.35
| Facility | | $8,912.51 | $21,877.62 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,890.45 / $7,585.78 / $9,772.37
| Professional | | $3,890.45 | $7,585.78 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,570.88 / $6,606.93 / $10,715.19
| Professional | | $4,570.88 | $6,606.93 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,918.31 / $6,918.31 / $7,762.47
| Professional | | $6,918.31 | $6,918.31 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $6,165.95 / $15,135.61
| Facility | | $3,311.31 | $6,165.95 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $5,370.32 / $11,748.98
| Professional | | $3,801.89 | $5,370.32 | $11,748.98 |