- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,090.00 / $8,031.00 / $11,356.00
| Facility | | $4,090.00 | $8,031.00 | $11,356.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $905.90 / $1,019.11 / $1,902.07
| Professional | | $905.90 | $1,019.11 | $1,902.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,508.00 / $9,678.00 / $17,206.00
| Facility | | $7,508.00 | $9,678.00 | $17,206.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.79 / $1,412.97 / $1,702.81
| Professional | | $638.79 | $1,412.97 | $1,702.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $815.72 / $1,063.34 / $2,067.16
| Professional | | $815.72 | $1,063.34 | $2,067.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $944.87 / $1,086.00 / $1,086.00
| Professional | | $944.87 | $1,086.00 | $1,086.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,943.00 / $10,797.00 / $18,470.00
| Facility | | $6,943.00 | $10,797.00 | $18,470.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.77 / $1,032.54 / $2,014.15
| Professional | | $673.77 | $1,032.54 | $2,014.15 |