- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $6,309.57 / $12,022.64
| Facility | | $4,786.30 | $6,309.57 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,570.88 / $6,309.57 / $10,715.19
| Professional | | $4,570.88 | $6,309.57 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $6,606.93 / $23,988.33
| Facility | | $4,897.79 | $6,606.93 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $6,456.54 / $14,454.40
| Professional | | $6,309.57 | $6,456.54 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $8,317.64 / $47,863.01
| Facility | | $8,317.64 | $8,317.64 | $47,863.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,025.60 / $6,025.60 / $18,620.87
| Professional | | $6,025.60 | $6,025.60 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $7,943.28 / $14,454.40
| Facility | | $4,365.16 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $6,165.95 / $9,120.11
| Professional | | $4,365.16 | $6,165.95 | $9,120.11 |