- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $584.41 / $605.04 / $6,740.70
| Facility | | $584.41 | $605.04 | $6,740.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $764.83 / $9,065.32 / $16,262.00
| Professional | | $764.83 | $9,065.32 | $16,262.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $639.41 / $823.84 / $7,659.89
| Professional | | $639.41 | $823.84 | $7,659.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,855.00 / $12,685.00 / $23,031.00
| Facility | | $5,855.00 | $12,685.00 | $23,031.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,361.92 / $5,744.91 / $11,585.75
| Professional | | $5,361.92 | $5,744.91 | $11,585.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,904.97 / $8,857.45 / $11,788.52
| Professional | | $5,904.97 | $8,857.45 | $11,788.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,234.04 / $13,086.91 / $23,554.56
| Professional | | $9,234.04 | $13,086.91 | $23,554.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.50 / $3,986.35 / $3,986.35
| Professional | | $515.50 | $3,986.35 | $3,986.35 |