- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $6,918.31 / $31,622.78
| Facility | | $6,760.83 | $6,918.31 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $4,168.69 / $4,897.79
| Professional | | $2,818.38 | $4,168.69 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $11,481.54 / $12,302.69
| Facility | | $5,128.61 | $11,481.54 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,495.41 / $6,918.31 / $11,220.18
| Professional | | $5,495.41 | $6,918.31 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $11,481.54 / $29,512.09
| Facility | | $134.90 | $11,481.54 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,168.69 / $4,168.69 / $5,248.07
| Professional | | $4,168.69 | $4,168.69 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $5,248.07 / $10,715.19
| Facility | | $2,454.71 | $5,248.07 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,162.28 / $5,495.41
| Professional | | $2,089.30 | $3,162.28 | $5,495.41 |