- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $2,344.23 / $4,897.79
| Facility | | $501.19 | $2,344.23 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $537.03 / $812.83
| Professional | | $467.74 | $537.03 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $8,709.64 / $11,220.18
| Facility | | $4,265.80 | $8,709.64 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $676.08 / $1,023.29
| Professional | | $371.54 | $676.08 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $478.63 / $501.19
| Facility | | $426.58 | $478.63 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $676.08 / $1,000.00
| Professional | | $467.74 | $676.08 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $5,754.40 / $12,022.64
| Facility | | $1,412.54 | $5,754.40 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $616.60 / $1,000.00
| Professional | | $426.58 | $616.60 | $1,000.00 |