- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $975.04 / $6,075.00 / $11,298.69
| Facility | | $975.04 | $6,075.00 | $11,298.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.00 / $564.25 / $4,236.00
| Professional | | $128.00 | $564.25 | $4,236.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,771.16 / $13,307.77 / $23,333.99
| Facility | | $8,771.16 | $13,307.77 | $23,333.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,603.09 / $3,603.09 / $8,026.60
| Professional | | $3,603.09 | $3,603.09 | $8,026.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,807.33 / $5,331.00 / $15,114.42
| Facility | | $1,807.33 | $5,331.00 | $15,114.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $598.50 / $2,590.56 / $3,485.14
| Professional | | $598.50 | $2,590.56 | $3,485.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,960.00 / $7,872.00 / $11,531.00
| Facility | | $2,960.00 | $7,872.00 | $11,531.00 |