- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $4,365.16 / $10,964.78
| Facility | | $831.76 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $489.78 / $1,071.52
| Professional | | $398.11 | $489.78 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $6,456.54 / $14,791.08
| Facility | | $2,089.30 | $6,456.54 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $562.34 / $1,122.02
| Professional | | $389.05 | $562.34 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $1,023.29 / $3,467.37
| Facility | | $489.78 | $1,023.29 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $660.69 / $1,513.56
| Professional | | $436.52 | $660.69 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,174.90 / $3,548.13
| Facility | | $302.00 | $1,174.90 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $537.03 / $1,000.00
| Professional | | $380.19 | $537.03 | $1,000.00 |