- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.84 / $1,821.00 / $9,034.00
| Facility | | $501.84 | $1,821.00 | $9,034.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.61 / $1,846.16 / $2,993.74
| Professional | | $344.61 | $1,846.16 | $2,993.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,063.64 / $4,063.64 / $4,876.37
| Facility | | $4,063.64 | $4,063.64 | $4,876.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $470.13 / $2,205.08 / $2,918.49
| Professional | | $470.13 | $2,205.08 | $2,918.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.12 / $832.80 / $4,015.54
| Professional | | $428.12 | $832.80 | $4,015.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,565.00 / $2,828.00 / $6,957.00
| Facility | | $1,565.00 | $2,828.00 | $6,957.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,947.39 / $2,555.94 / $4,353.68
| Professional | | $1,947.39 | $2,555.94 | $4,353.68 |