- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $5,370.32 / $12,302.69
| Facility | | $676.08 | $5,370.32 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $562.34 / $1,000.00
| Professional | | $190.55 | $562.34 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $9,549.93 / $17,378.01
| Facility | | $4,786.30 | $9,549.93 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $588.84 / $1,122.02
| Professional | | $213.80 | $588.84 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $489.78 / $1,096.48
| Professional | | $245.47 | $489.78 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $870.96 / $1,348.96
| Professional | | $223.87 | $870.96 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $575.44 / $602.56
| Professional | | $158.49 | $575.44 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $8,511.38 / $16,595.87
| Facility | | $3,548.13 | $8,511.38 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $630.96 / $1,202.26
| Professional | | $245.47 | $630.96 | $1,202.26 |