- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $6,025.60 / $10,471.29
| Facility | | $4,570.88 | $6,025.60 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,168.69 / $7,585.78
| Professional | | $3,311.31 | $4,168.69 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $17,378.01 / $31,622.78
| Facility | | $8,912.51 | $17,378.01 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $7,585.78 / $8,511.38
| Professional | | $3,467.37 | $7,585.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,890.45 / $5,754.40 / $9,332.54
| Professional | | $3,890.45 | $5,754.40 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,754.40 / $5,754.40 / $6,309.57
| Professional | | $5,754.40 | $5,754.40 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $6,165.95 / $15,135.61
| Facility | | $3,311.31 | $6,165.95 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $5,754.40 / $10,964.78
| Professional | | $3,548.13 | $5,754.40 | $10,964.78 |