- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,467.37 / $6,760.83
| Facility | | $933.25 | $3,467.37 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,168.69 / $5,011.87 / $8,912.51
| Professional | | $4,168.69 | $5,011.87 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,888.44 / $6,456.54 / $7,943.28
| Professional | | $5,888.44 | $6,456.54 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $4,265.80 / $4,265.80
| Facility | | $39.81 | $4,265.80 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $812.83 / $7,943.28
| Facility | | $489.78 | $812.83 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $6,165.95 / $10,715.19
| Professional | | $3,715.35 | $6,165.95 | $10,715.19 |
- 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
- $3,981.07 / $5,248.07 / $8,912.51
| Professional | | $3,981.07 | $5,248.07 | $8,912.51 |