- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.37 / $3,336.40 / $4,707.00
| Facility | | $816.37 | $3,336.40 | $4,707.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $545.04 / $816.37 / $3,081.77
| Professional | | $545.04 | $816.37 | $3,081.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $589.20 / $836.81 / $1,646.28
| Professional | | $589.20 | $836.81 | $1,646.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.47 / $346.84 / $570.75
| Professional | | $61.47 | $346.84 | $570.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,684.92 / $6,137.22 / $8,943.69
| Facility | | $4,684.92 | $6,137.22 | $8,943.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $782.40 / $930.42 / $1,381.66
| Professional | | $782.40 | $930.42 | $1,381.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $6,097.00 / $8,267.00
| Facility | | $2,155.00 | $6,097.00 | $8,267.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.73 / $626.41 / $998.88
| Professional | | $508.73 | $626.41 | $998.88 |