- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.13 / $7,259.21 / $45,804.53
| Facility | | $756.13 | $7,259.21 | $45,804.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $463.06 / $7,648.22 / $31,657.83
| Professional | | $463.06 | $7,648.22 | $31,657.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $663.00 / $9,531.42 / $12,773.75
| Professional | | $663.00 | $9,531.42 | $12,773.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,468.45 / $5,525.18 / $7,609.39
| Professional | | $4,468.45 | $5,525.18 | $7,609.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,988.87 / $33,247.55 / $48,451.20
| Facility | | $20,988.87 | $33,247.55 | $48,451.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $669.16 / $1,678.82 / $17,034.55
| Professional | | $669.16 | $1,678.82 | $17,034.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,340.00 / $10,927.00 / $11,487.00
| Facility | | $3,340.00 | $10,927.00 | $11,487.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,153.73 / $8,419.62 / $15,608.16
| Professional | | $7,153.73 | $8,419.62 | $15,608.16 |