- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,911.64 / $3,812.06 / $3,964.54
| Facility | | $2,911.64 | $3,812.06 | $3,964.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,403.52 / $4,536.64 / $5,390.26
| Professional | | $3,403.52 | $4,536.64 | $5,390.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,986.28 / $8,010.09 / $8,418.60
| Facility | | $4,986.28 | $8,010.09 | $8,418.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,053.22 / $4,810.89 / $5,066.53
| Professional | | $4,053.22 | $4,810.89 | $5,066.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,007.57 / $11,294.23 / $15,265.39
| Facility | | $6,007.57 | $11,294.23 | $15,265.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,010.09 / $10,813.62 / $14,157.85
| Professional | | $8,010.09 | $10,813.62 | $14,157.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,541.83 / $6,541.83 / $10,448.18
| Facility | | $6,541.83 | $6,541.83 | $10,448.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,775.54 / $6,541.83 / $43,791.48
| Professional | | $4,775.54 | $6,541.83 | $43,791.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,186.10 / $5,105.00 / $6,381.25
| Professional | | $4,186.10 | $5,105.00 | $6,381.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,664.10 / $4,099.81 / $6,408.07
| Professional | | $2,664.10 | $4,099.81 | $6,408.07 |