- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,513.56 / $2,454.71
| Facility | | $831.76 | $1,513.56 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $776.25 / $1,000.00
| Professional | | $588.84 | $776.25 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $5,248.07 / $7,244.36
| Facility | | $5,248.07 | $5,248.07 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $851.14
| Professional | | $645.65 | $645.65 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $3,235.94
| Facility | | $3,235.94 | $3,235.94 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $977.24 / $1,174.90
| Professional | | $478.63 | $977.24 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,951.21 / $11,220.18
| Facility | | $1,230.27 | $2,951.21 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $660.69 / $1,202.26
| Professional | | $549.54 | $660.69 | $1,202.26 |