- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,623.41 / $7,762.47
| Facility | | $2,137.96 | $5,623.41 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,370.32 / $9,549.93
| Professional | | $4,466.84 | $5,370.32 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $5,248.07 / $8,128.31
| Professional | | $1,348.96 | $5,248.07 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,168.69 / $5,623.41 / $13,803.84
| Professional | | $4,168.69 | $5,623.41 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $4,897.79 / $10,964.78
| Professional | | $4,677.35 | $4,897.79 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,344.23 / $6,309.57
| Facility | | $645.65 | $2,344.23 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,890.45 / $5,370.32 / $11,220.18
| Professional | | $3,890.45 | $5,370.32 | $11,220.18 |