- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $520.30 / $2,553.85 / $6,812.38
| Facility | | $520.30 | $2,553.85 | $6,812.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $395.88 / $600.00 / $2,396.75
| Professional | | $395.88 | $600.00 | $2,396.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,182.40 / $4,243.12 / $8,055.25
| Facility | | $2,182.40 | $4,243.12 | $8,055.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $979.42 / $1,248.76 / $1,797.24
| Professional | | $979.42 | $1,248.76 | $1,797.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $534.27 / $2,451.00 / $8,207.90
| Facility | | $534.27 | $2,451.00 | $8,207.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,357.88 / $2,813.77 / $5,008.33
| Professional | | $1,357.88 | $2,813.77 | $5,008.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $805.44 / $1,958.85 / $3,305.56
| Professional | | $805.44 | $1,958.85 | $3,305.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $523.83 / $1,469.14 / $5,112.47
| Professional | | $523.83 | $1,469.14 | $5,112.47 |