- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $4,786.30 / $5,495.41
| Facility | | $4,365.16 | $4,786.30 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $5,248.07 / $7,762.47
| Professional | | $4,365.16 | $5,248.07 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $6,606.93 / $7,762.47
| Facility | | $6,606.93 | $6,606.93 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,897.79 / $4,897.79 / $6,606.93
| Professional | | $4,897.79 | $4,897.79 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $6,309.57 / $10,471.29
| Professional | | $2,344.23 | $6,309.57 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,317.64 / $8,317.64 / $8,511.38
| Professional | | $8,317.64 | $8,317.64 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $6,918.31 / $10,232.93
| Facility | | $4,168.69 | $6,918.31 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,128.61 / $6,918.31
| Professional | | $4,466.84 | $5,128.61 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,623.41 / $5,623.41 / $10,471.29
| Professional | | $5,623.41 | $5,623.41 | $10,471.29 |