- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,917.09 / $7,321.66 / $10,982.50
| Facility | | $3,917.09 | $7,321.66 | $10,982.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,660.82 / $4,403.02 / $31,896.49
| Professional | | $3,660.82 | $4,403.02 | $31,896.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,106.11 / $12,574.95 / $20,321.74
| Facility | | $3,106.11 | $12,574.95 | $20,321.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,372.71 / $3,451.23 / $23,287.29
| Professional | | $2,372.71 | $3,451.23 | $23,287.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,453.62 / $3,660.83 / $3,660.83
| Facility | | $3,453.62 | $3,660.83 | $3,660.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,660.83 / $3,660.83 / $3,660.83
| Professional | | $3,660.83 | $3,660.83 | $3,660.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,621.05 / $4,742.55 / $5,723.93
| Facility | | $3,621.05 | $4,742.55 | $5,723.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,638.86 / $3,638.86 / $3,638.86
| Professional | | $3,638.86 | $3,638.86 | $3,638.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,660.83 / $3,660.83 / $3,660.83
| Professional | | $3,660.83 | $3,660.83 | $3,660.83 |