- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $9,332.54 / $25,118.86
| Facility | | $4,570.88 | $9,332.54 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,570.88 / $8,128.31
| Professional | | $3,630.78 | $4,570.88 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $7,244.36 / $24,547.09
| Facility | | $5,370.32 | $7,244.36 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,630.27 / $8,912.51
| Professional | | $2,187.76 | $2,630.27 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $10,471.29 / $24,547.09
| Facility | | $3,548.13 | $10,471.29 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $6,309.57 / $13,182.57
| Professional | | $2,630.27 | $6,309.57 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $5,495.41 / $6,606.93
| Facility | | $3,235.94 | $5,495.41 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,311.31 / $6,606.93
| Professional | | $2,290.87 | $3,311.31 | $6,606.93 |