- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $5,128.61 / $9,772.37
| Facility | | $4,168.69 | $5,128.61 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,981.07 / $5,248.07 / $8,511.38
| Professional | | $3,981.07 | $5,248.07 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $5,623.41 / $19,498.45
| Facility | | $4,168.69 | $5,623.41 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,128.61 / $5,495.41 / $12,302.69
| Professional | | $5,128.61 | $5,495.41 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $6,606.93 / $38,018.94
| Facility | | $6,606.93 | $6,606.93 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,786.30 / $4,786.30 / $14,791.08
| Professional | | $4,786.30 | $4,786.30 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $6,760.83 / $12,302.69
| Facility | | $3,981.07 | $6,760.83 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $4,897.79 / $7,762.47
| Professional | | $3,801.89 | $4,897.79 | $7,762.47 |