- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $3,890.45 / $10,964.78
| Facility | | $794.33 | $3,890.45 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $1,000.00 / $2,187.76
| Professional | | $323.59 | $1,000.00 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $7,079.46 / $15,135.61
| Facility | | $2,398.83 | $7,079.46 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $1,202.26 / $2,754.23
| Professional | | $338.84 | $1,202.26 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $3,630.78 / $12,302.69
| Facility | | $524.81 | $3,630.78 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $1,096.48 / $3,311.31
| Professional | | $354.81 | $1,096.48 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,623.41 / $12,882.50
| Facility | | $1,995.26 | $5,623.41 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $1,096.48 / $2,511.89
| Professional | | $323.59 | $1,096.48 | $2,511.89 |