- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,590.71 / $3,633.33 / $8,246.09
| Facility | | $2,590.71 | $3,633.33 | $8,246.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.00 / $2,464.35 / $2,685.51
| Professional | | $477.00 | $2,464.35 | $2,685.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $345.28 / $4,636.45 / $12,321.74
| Facility | | $345.28 | $4,636.45 | $12,321.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.00 / $239.20 / $2,353.76
| Professional | | $208.00 | $239.20 | $2,353.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,819.62 / $5,339.41 / $9,477.45
| Facility | | $2,819.62 | $5,339.41 | $9,477.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,791.30 / $3,848.09 / $4,610.43
| Professional | | $3,791.30 | $3,848.09 | $4,610.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,843.48 / $2,843.48 / $2,843.48
| Facility | | $2,843.48 | $2,843.48 | $2,843.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.96 / $1,895.65 / $3,573.30
| Professional | | $1,326.96 | $1,895.65 | $3,573.30 |