- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $477.00 / $3,159.42 / $18,071.90
| Facility | | $477.00 | $3,159.42 | $18,071.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.00 / $477.00 / $2,685.51
| Professional | | $477.00 | $477.00 | $2,685.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,088.33 / $6,964.07 / $14,477.57
| Facility | | $3,088.33 | $6,964.07 | $14,477.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,317.39 / $4,138.84 / $5,756.46
| Professional | | $3,317.39 | $4,138.84 | $5,756.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,637.36 / $3,159.42 / $8,702.00
| Facility | | $1,637.36 | $3,159.42 | $8,702.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.68 / $1,737.68 / $1,737.68
| Facility | | $1,737.68 | $1,737.68 | $1,737.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.96 / $1,895.65 / $3,222.61
| Professional | | $1,326.96 | $1,895.65 | $3,222.61 |