- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,729.39 / $7,193.00 / $27,654.20
| Facility | | $4,729.39 | $7,193.00 | $27,654.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,812.29 / $4,729.39 / $5,357.94
| Professional | | $3,812.29 | $4,729.39 | $5,357.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,004.36 / $8,432.35 / $17,333.68
| Facility | | $6,004.36 | $8,432.35 | $17,333.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,668.43 / $6,816.12 / $13,774.88
| Professional | | $3,668.43 | $6,816.12 | $13,774.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,749.05 / $23,135.41 / $41,284.49
| Facility | | $10,749.05 | $23,135.41 | $41,284.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,090.27 / $6,827.85 / $14,942.91
| Professional | | $4,090.27 | $6,827.85 | $14,942.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,035.10 / $9,581.08 / $13,666.70
| Professional | | $5,035.10 | $9,581.08 | $13,666.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,308.78 / $4,315.80 / $12,623.00
| Professional | | $3,308.78 | $4,315.80 | $12,623.00 |