- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,454.71 / $8,511.38
| Facility | | $2,344.23 | $2,454.71 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,454.71 / $6,025.60
| Professional | | $2,238.72 | $2,454.71 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $5,754.40 / $6,918.31
| Professional | | $4,677.35 | $5,754.40 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $4,570.88 / $7,413.10
| Professional | | $2,818.38 | $4,570.88 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,388.44 / $4,897.79
| Facility | | $2,454.71 | $3,388.44 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $4,570.88 / $18,620.87
| Professional | | $2,454.71 | $4,570.88 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,041.74 / $2,041.74
| Facility | | $1,819.70 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $4,570.88 / $6,025.60
| Professional | | $2,454.71 | $4,570.88 | $6,025.60 |