- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $322.41 / $1,277.00 / $3,804.00
| Facility | | $322.41 | $1,277.00 | $3,804.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.87 / $251.53 / $324.75
| Professional | | $179.87 | $251.53 | $324.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.46 / $3,308.46 / $3,970.15
| Facility | | $3,308.46 | $3,308.46 | $3,970.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.32 / $284.30 / $404.96
| Professional | | $193.32 | $284.30 | $404.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.59 / $278.77 / $433.32
| Professional | | $157.59 | $278.77 | $433.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,240.00 / $2,314.00 / $5,652.00
| Facility | | $1,240.00 | $2,314.00 | $5,652.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.44 / $331.95 / $562.15
| Professional | | $272.44 | $331.95 | $562.15 |