- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $366.54 / $6,387.01 / $11,321.00
| Facility | | $366.54 | $6,387.01 | $11,321.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.07 / $992.24 / $6,387.01
| Professional | | $283.07 | $992.24 | $6,387.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.17 / $908.46 / $13,498.41
| Professional | | $330.17 | $908.46 | $13,498.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $564.94 / $6,494.62 / $7,429.14
| Professional | | $564.94 | $6,494.62 | $7,429.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,250.00 / $22,250.00 / $48,933.97
| Facility | | $22,250.00 | $22,250.00 | $48,933.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.46 / $4,803.35 / $8,976.17
| Professional | | $255.46 | $4,803.35 | $8,976.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,066.00 / $12,315.00 / $27,214.00
| Facility | | $6,066.00 | $12,315.00 | $27,214.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,722.43 / $6,305.33 / $16,065.34
| Professional | | $3,722.43 | $6,305.33 | $16,065.34 |