- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $466.35 / $4,112.00 / $4,933.00
| Facility | | $466.35 | $4,112.00 | $4,933.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.22 / $446.03 / $466.35
| Professional | | $294.22 | $446.03 | $466.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,669.65 / $13,217.56 / $30,480.75
| Facility | | $9,669.65 | $13,217.56 | $30,480.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,381.24 / $7,351.14 / $10,446.35
| Professional | | $1,381.24 | $7,351.14 | $10,446.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.30 / $4,112.00 / $4,933.00
| Facility | | $512.30 | $4,112.00 | $4,933.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.35 / $512.30 / $652.66
| Professional | | $466.35 | $512.30 | $652.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,850.00 / $11,854.00 / $19,979.00
| Facility | | $6,850.00 | $11,854.00 | $19,979.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.77 / $635.53 / $860.84
| Professional | | $530.77 | $635.53 | $860.84 |