- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.11 / $2,023.00 / $5,607.00
| Facility | | $606.11 | $2,023.00 | $5,607.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.86 / $3,212.00 / $6,485.05
| Professional | | $469.86 | $3,212.00 | $6,485.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,275.63 / $11,907.70 / $23,987.44
| Facility | | $6,275.63 | $11,907.70 | $23,987.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $585.10 / $868.32 / $7,633.06
| Professional | | $585.10 | $868.32 | $7,633.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,501.39 / $9,501.39 / $9,501.39
| Facility | | $9,501.39 | $9,501.39 | $9,501.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.46 / $1,209.33 / $7,236.24
| Professional | | $455.46 | $1,209.33 | $7,236.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,215.00 / $8,928.00 / $19,270.00
| Facility | | $1,215.00 | $8,928.00 | $19,270.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,499.84 / $6,583.25 / $9,750.10
| Professional | | $4,499.84 | $6,583.25 | $9,750.10 |