- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $535.67 / $1,850.00 / $3,945.00
| Facility | | $535.67 | $1,850.00 | $3,945.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.62 / $469.90 / $535.67
| Professional | | $441.62 | $469.90 | $535.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,123.60 / $17,027.57 / $30,466.12
| Facility | | $9,123.60 | $17,027.57 | $30,466.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,449.00 / $10,023.73 / $21,405.00
| Facility | | $1,449.00 | $10,023.73 | $21,405.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.82 / $710.03 / $1,009.21
| Professional | | $437.82 | $710.03 | $1,009.21 |