- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $985.50 / $4,527.50 / $9,882.37
| Facility | | $985.50 | $4,527.50 | $9,882.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $687.89 / $761.80 / $1,322.73
| Professional | | $687.89 | $761.80 | $1,322.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,432.00 / $9,458.00 / $17,206.00
| Facility | | $4,432.00 | $9,458.00 | $17,206.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $738.20 / $1,000.52 / $1,527.33
| Professional | | $738.20 | $1,000.52 | $1,527.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,012.85 / $3,736.36 / $4,998.04
| Facility | | $3,012.85 | $3,736.36 | $4,998.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $762.25 / $1,113.67 / $1,714.26
| Professional | | $762.25 | $1,113.67 | $1,714.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,596.00 / $9,172.00 / $15,903.00
| Facility | | $4,596.00 | $9,172.00 | $15,903.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $752.07 / $1,059.38 / $1,832.82
| Professional | | $752.07 | $1,059.38 | $1,832.82 |