- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $6,918.31 / $14,454.40
| Facility | | $4,786.30 | $6,918.31 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,548.13 / $4,677.35
| Professional | | $2,630.27 | $3,548.13 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $7,413.10 / $12,882.50
| Facility | | $5,248.07 | $7,413.10 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,801.89 / $10,471.29
| Professional | | $2,454.71 | $3,801.89 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,090.30 / $27,542.29
| Facility | | $3,090.30 | $3,090.30 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,456.54 / $8,912.51 / $10,471.29
| Professional | | $6,456.54 | $8,912.51 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,884.03 / $8,317.64
| Professional | | $2,290.87 | $2,884.03 | $8,317.64 |