- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,287.66 / $4,863.00 / $5,018.74
| Facility | | $3,287.66 | $4,863.00 | $5,018.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,287.66 / $3,767.12 / $6,849.30
| Professional | | $3,287.66 | $3,767.12 | $6,849.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,196.04 / $7,555.84 / $33,216.92
| Facility | | $7,196.04 | $7,555.84 | $33,216.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,670.43 / $3,670.43 / $5,821.91
| Professional | | $3,670.43 | $3,670.43 | $5,821.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,728.96 / $4,728.96 / $4,728.96
| Facility | | $4,728.96 | $4,728.96 | $4,728.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,452.14 / $3,452.14 / $4,870.83
| Professional | | $3,452.14 | $3,452.14 | $4,870.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,287.66 / $5,799.44 / $34,402.54
| Facility | | $3,287.66 | $5,799.44 | $34,402.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,540.69 / $3,846.56 / $6,457.91
| Professional | | $2,540.69 | $3,846.56 | $6,457.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,148.31 / $8,148.31 / $9,777.96
| Facility | | $8,148.31 | $8,148.31 | $9,777.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,540.69 / $3,590.02 / $4,827.31
| Professional | | $2,540.69 | $3,590.02 | $4,827.31 |