- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $4,073.80 / $10,964.78
| Facility | | $831.76 | $4,073.80 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $891.25 / $1,949.84
| Professional | | $295.12 | $891.25 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,888.44 / $13,489.63
| Facility | | $2,089.30 | $5,888.44 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $1,047.13 / $2,570.40
| Professional | | $309.03 | $1,047.13 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $4,073.80 / $17,378.01
| Facility | | $512.86 | $4,073.80 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $1,000.00 / $3,090.30
| Professional | | $316.23 | $1,000.00 | $3,090.30 |
- 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
- $281.84 / $954.99 / $2,187.76
| Professional | | $281.84 | $954.99 | $2,187.76 |