- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $841.00 / $2,694.00 / $5,150.00
| Facility | | $841.00 | $2,694.00 | $5,150.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,206.25 / $2,926.40 / $3,603.81
| Professional | | $2,206.25 | $2,926.40 | $3,603.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,829.62 / $4,819.04 / $7,020.75
| Facility | | $2,829.62 | $4,819.04 | $7,020.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,717.39 / $3,063.03 / $3,480.91
| Professional | | $2,717.39 | $3,063.03 | $3,480.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,966.61 / $2,839.30 / $4,449.87
| Professional | | $1,966.61 | $2,839.30 | $4,449.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.00 / $3,238.00 / $8,257.00
| Facility | | $882.00 | $3,238.00 | $8,257.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,226.01 / $2,782.51 / $4,437.60
| Professional | | $2,226.01 | $2,782.51 | $4,437.60 |