- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $6,309.57 / $9,549.93
| Facility | | $4,570.88 | $6,309.57 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,890.45 / $5,011.87 / $8,709.64
| Professional | | $3,890.45 | $5,011.87 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $6,309.57 / $12,302.69
| Facility | | $2,238.72 | $6,309.57 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $6,918.31 / $9,772.37
| Professional | | $4,265.80 | $6,918.31 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $549.54 / $549.54
| Facility | | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $7,244.36 / $12,882.50
| Professional | | $4,265.80 | $7,244.36 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,754.40 / $8,317.64
| Professional | | $4,466.84 | $5,754.40 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $3,235.94 / $7,943.28
| Facility | | $602.56 | $3,235.94 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $6,025.60 / $11,748.98
| Professional | | $4,365.16 | $6,025.60 | $11,748.98 |