- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $9,772.37 / $26,915.35
| Facility | | $5,370.32 | $9,772.37 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,019.95 / $4,786.30
| Professional | | $2,089.30 | $3,019.95 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $7,413.10 / $22,387.21
| Facility | | $6,606.93 | $7,413.10 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,511.89 / $3,630.78
| Professional | | $1,548.82 | $2,511.89 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $14,125.38 / $16,982.44
| Facility | | $6,309.57 | $14,125.38 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,073.80 / $16,218.10
| Professional | | $1,995.26 | $4,073.80 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,890.45 / $3,890.45 / $7,413.10
| Professional | | $3,890.45 | $3,890.45 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,344.23 / $8,317.64
| Professional | | $2,344.23 | $2,344.23 | $8,317.64 |