- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $5,888.44 / $10,715.19
| Facility | | $4,365.16 | $5,888.44 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $2,137.96 / $8,511.38
| Professional | | $562.34 | $2,137.96 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $1,071.52 / $25,118.86
| Facility | | $199.53 | $1,071.52 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $851.14 / $1,000.00
| Professional | | $794.33 | $851.14 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,884.03 / $7,762.47
| Facility | | $1,318.26 | $2,884.03 | $7,762.47 |