- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.22 / $5,743.00 / $9,918.95
| Facility | | $748.22 | $5,743.00 | $9,918.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.89 / $5,594.06 / $12,063.32
| Professional | | $456.89 | $5,594.06 | $12,063.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $573.28 / $4,801.26 / $10,738.49
| Professional | | $573.28 | $4,801.26 | $10,738.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.34 / $3,852.20 / $5,148.79
| Professional | | $458.34 | $3,852.20 | $5,148.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,361.94 / $13,564.50 / $19,767.36
| Facility | | $10,361.94 | $13,564.50 | $19,767.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $784.86 / $1,561.79 / $18,553.83
| Professional | | $784.86 | $1,561.79 | $18,553.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $9,753.00 / $22,387.00
| Facility | | $3,028.00 | $9,753.00 | $22,387.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,602.76 / $7,345.24 / $11,300.42
| Professional | | $5,602.76 | $7,345.24 | $11,300.42 |