- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $603.54 / $1,277.00 / $3,804.00
| Facility | | $603.54 | $1,277.00 | $3,804.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.31 / $600.66 / $726.92
| Professional | | $458.31 | $600.66 | $726.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,027.36 / $3,027.36 / $3,632.83
| Facility | | $3,027.36 | $3,027.36 | $3,632.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.83 / $664.79 / $703.90
| Professional | | $531.83 | $664.79 | $703.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,221.52 / $2,221.52 / $2,221.52
| Facility | | $2,221.52 | $2,221.52 | $2,221.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $543.34 / $756.75 / $931.96
| Professional | | $543.34 | $756.75 | $931.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $980.00 / $1,593.08 / $4,064.00
| Facility | | $980.00 | $1,593.08 | $4,064.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.72 / $658.85 / $1,002.31
| Professional | | $458.72 | $658.85 | $1,002.31 |