- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $596.33 / $1,277.00 / $3,804.00
| Facility | | $596.33 | $1,277.00 | $3,804.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $443.84 / $587.87 / $688.74
| Professional | | $443.84 | $587.87 | $688.74 |
- 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
- $541.40 / $676.75 / $716.56
| Professional | | $541.40 | $676.75 | $716.56 |
- 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
- $530.02 / $743.55 / $942.15
| Professional | | $530.02 | $743.55 | $942.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $980.00 / $1,650.00 / $4,064.00
| Facility | | $980.00 | $1,650.00 | $4,064.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.05 / $616.09 / $933.16
| Professional | | $450.05 | $616.09 | $933.16 |