- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,467.37 / $6,309.57
| Facility | | $933.25 | $3,467.37 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,466.84 / $7,943.28
| Professional | | $3,715.35 | $4,466.84 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,897.79 / $5,888.44 / $6,918.31
| Professional | | $4,897.79 | $5,888.44 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $3,801.89 / $3,801.89
| Facility | | $39.81 | $3,801.89 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $812.83 / $7,244.36
| Facility | | $489.78 | $812.83 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $5,370.32 / $9,772.37
| Professional | | $3,162.28 | $5,370.32 | $9,772.37 |
- 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
- $3,548.13 / $4,570.88 / $7,762.47
| Professional | | $3,548.13 | $4,570.88 | $7,762.47 |