- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,466.84 / $8,912.51
| Facility | | $3,715.35 | $4,466.84 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,466.84 / $7,413.10
| Professional | | $3,715.35 | $4,466.84 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $4,897.79 / $17,378.01
| Facility | | $3,548.13 | $4,897.79 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,370.32 / $10,471.29
| Professional | | $4,466.84 | $5,370.32 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $6,025.60 / $32,359.37
| Facility | | $6,025.60 | $6,025.60 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $4,365.16 / $12,589.25
| Professional | | $4,365.16 | $4,365.16 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $6,025.60 / $10,471.29
| Facility | | $4,265.80 | $6,025.60 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,365.16 / $6,606.93
| Professional | | $3,235.94 | $4,365.16 | $6,606.93 |