- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $956.90 / $3,446.08 / $8,074.63
| Facility | | $956.90 | $3,446.08 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $766.40 / $941.43 / $1,403.76
| Professional | | $766.40 | $941.43 | $1,403.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,527.42 / $10,726.34 / $19,930.64
| Facility | | $5,527.42 | $10,726.34 | $19,930.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $882.94 / $1,136.90 / $1,826.81
| Professional | | $882.94 | $1,136.90 | $1,826.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,087.19 / $1,087.19 / $1,510.62
| Facility | | $1,087.19 | $1,087.19 | $1,510.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.42 / $1,309.49 / $2,015.82
| Professional | | $912.42 | $1,309.49 | $2,015.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,500.00 / $8,198.00
| Facility | | $1,403.00 | $3,500.00 | $8,198.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $878.59 / $1,219.01 / $2,121.17
| Professional | | $878.59 | $1,219.01 | $2,121.17 |