- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.05 / $6,707.00 / $13,092.00
| Facility | | $281.05 | $6,707.00 | $13,092.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.87 / $2,305.62 / $3,131.41
| Professional | | $146.87 | $2,305.62 | $3,131.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.82 / $542.50 / $6,984.54
| Professional | | $188.82 | $542.50 | $6,984.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.85 / $3,628.10 / $4,459.91
| Professional | | $312.85 | $3,628.10 | $4,459.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,180.88 / $14,382.16 / $31,187.56
| Facility | | $13,180.88 | $14,382.16 | $31,187.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.47 / $2,687.15 / $4,602.81
| Professional | | $137.47 | $2,687.15 | $4,602.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,682.00 / $9,969.00 / $19,696.00
| Facility | | $5,682.00 | $9,969.00 | $19,696.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,880.57 / $3,762.18 / $7,085.05
| Professional | | $1,880.57 | $3,762.18 | $7,085.05 |