- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,019.95 / $6,606.93
| Facility | | $933.25 | $3,019.95 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $5,370.32 / $9,549.93
| Professional | | $4,365.16 | $5,370.32 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,165.95 / $6,760.83 / $8,511.38
| Professional | | $6,165.95 | $6,760.83 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $4,365.16 / $4,365.16
| Facility | | $39.81 | $4,365.16 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $812.83 / $8,317.64
| Facility | | $489.78 | $812.83 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $6,456.54 / $11,481.54
| Professional | | $3,715.35 | $6,456.54 | $11,481.54 |
- 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
- $4,168.69 / $5,495.41 / $9,332.54
| Professional | | $4,168.69 | $5,495.41 | $9,332.54 |