- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $6,918.31 / $33,884.42
| Facility | | $4,265.80 | $6,918.31 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $5,248.07 / $8,709.64
| Professional | | $4,265.80 | $5,248.07 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,677.35 / $11,481.54
| Facility | | $3,630.78 | $4,677.35 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,073.80 / $7,244.36 / $11,748.98
| Professional | | $4,073.80 | $7,244.36 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $5,623.41 / $42,657.95
| Facility | | $5,623.41 | $5,623.41 | $42,657.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,786.30 / $4,786.30 / $15,135.61
| Professional | | $4,786.30 | $4,786.30 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $6,918.31 / $7,079.46
| Facility | | $3,548.13 | $6,918.31 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $5,011.87 / $8,128.31
| Professional | | $3,715.35 | $5,011.87 | $8,128.31 |