- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,255.92 / $4,816.04 / $4,970.27
| Facility | | $3,255.92 | $4,816.04 | $4,970.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,255.92 / $4,069.23 / $6,783.16
| Professional | | $3,255.92 | $4,069.23 | $6,783.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,126.55 / $7,482.88 / $32,896.15
| Facility | | $7,126.55 | $7,482.88 | $32,896.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,875.48 / $4,353.79 / $5,768.37
| Professional | | $3,875.48 | $4,353.79 | $5,768.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,938.58 / $4,938.58 / $4,938.58
| Facility | | $4,938.58 | $4,938.58 | $4,938.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,605.16 / $3,605.16 / $5,086.74
| Professional | | $3,605.16 | $3,605.16 | $5,086.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,313.51 / $6,049.66 / $37,094.85
| Facility | | $3,313.51 | $6,049.66 | $37,094.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,962.80 / $3,870.14 / $7,601.65
| Professional | | $2,962.80 | $3,870.14 | $7,601.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,783.81 / $3,594.68 / $5,992.87
| Professional | | $2,783.81 | $3,594.68 | $5,992.87 |