- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,183.00 / $4,775.03 / $8,258.09
| Facility | | $2,183.00 | $4,775.03 | $8,258.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.28 / $734.01 / $5,870.53
| Professional | | $166.28 | $734.01 | $5,870.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,920.00 / $14,097.00 / $20,501.00
| Facility | | $9,920.00 | $14,097.00 | $20,501.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.60 / $2,425.26 / $8,450.10
| Professional | | $245.60 | $2,425.26 | $8,450.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.27 / $614.54 / $7,697.86
| Professional | | $246.27 | $614.54 | $7,697.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,594.47 / $4,594.47 / $5,140.68
| Professional | | $4,594.47 | $4,594.47 | $5,140.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,272.00 / $11,009.00 / $20,692.00
| Facility | | $7,272.00 | $11,009.00 | $20,692.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,143.04 / $5,275.67 / $9,512.32
| Professional | | $3,143.04 | $5,275.67 | $9,512.32 |