- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,248.07 / $9,120.11
| Facility | | $4,466.84 | $5,248.07 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,248.07 / $8,709.64
| Professional | | $4,466.84 | $5,248.07 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $5,754.40 / $20,417.38
| Facility | | $4,168.69 | $5,754.40 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,623.41 / $12,302.69
| Professional | | $5,495.41 | $5,623.41 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $6,606.93 / $42,657.95
| Facility | | $6,606.93 | $6,606.93 | $42,657.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,897.79 / $4,897.79 / $14,791.08
| Professional | | $4,897.79 | $4,897.79 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,079.46 / $12,589.25
| Facility | | $4,570.88 | $7,079.46 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $5,128.61 / $7,943.28
| Professional | | $3,801.89 | $5,128.61 | $7,943.28 |