- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $5,370.32 / $9,120.11
| Facility | | $4,073.80 | $5,370.32 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,073.80 / $5,370.32 / $9,120.11
| Professional | | $4,073.80 | $5,370.32 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $5,754.40 / $20,892.96
| Facility | | $4,265.80 | $5,754.40 | $20,892.96 |
- 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
- $7,244.36 / $7,244.36 / $40,738.03
| Facility | | $7,244.36 | $7,244.36 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,248.07 / $5,248.07 / $15,488.17
| Professional | | $5,248.07 | $5,248.07 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $6,918.31 / $12,589.25
| Facility | | $4,365.16 | $6,918.31 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $5,370.32 / $7,943.28
| Professional | | $3,801.89 | $5,370.32 | $7,943.28 |