- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,467.37 / $4,365.16
| Facility | | $933.25 | $3,467.37 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,090.30 / $5,495.41
| Professional | | $2,511.89 | $3,090.30 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,981.07 / $4,897.79
| Professional | | $3,467.37 | $3,981.07 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $2,570.40 / $2,570.40
| Facility | | $39.81 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $812.83 / $4,897.79
| Facility | | $489.78 | $812.83 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,715.35 / $6,606.93
| Professional | | $2,238.72 | $3,715.35 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,174.90 / $5,754.40
| Facility | | $371.54 | $1,174.90 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,090.30 / $5,370.32
| Professional | | $2,398.83 | $3,090.30 | $5,370.32 |