- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,672.02 / $6,910.70 / $7,132.01
| Facility | | $4,672.02 | $6,910.70 | $7,132.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,672.02 / $5,353.36 / $9,733.37
| Professional | | $4,672.02 | $5,353.36 | $9,733.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,226.12 / $10,737.43 / $47,203.77
| Facility | | $10,226.12 | $10,737.43 | $47,203.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,223.35 / $5,635.06 / $8,411.35
| Professional | | $5,223.35 | $5,635.06 | $8,411.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,652.12 / $6,652.12 / $6,652.12
| Facility | | $6,652.12 | $6,652.12 | $6,652.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,856.05 / $4,856.05 / $6,851.68
| Professional | | $4,856.05 | $4,856.05 | $6,851.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,672.02 / $8,241.44 / $48,028.27
| Facility | | $4,672.02 | $8,241.44 | $48,028.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,834.71 / $5,466.25 / $9,084.20
| Professional | | $3,834.71 | $5,466.25 | $9,084.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,834.71 / $5,101.70 / $7,241.63
| Professional | | $3,834.71 | $5,101.70 | $7,241.63 |