- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.00 / $1,831.00 / $7,632.52
| Facility | | $750.00 | $1,831.00 | $7,632.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,643.06 / $7,632.52 / $7,740.40
| Professional | | $2,643.06 | $7,632.52 | $7,740.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,784.00 / $4,784.00 / $4,784.00
| Professional | | $4,784.00 | $4,784.00 | $4,784.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $690.00 / $1,223.00 / $4,093.00
| Facility | | $690.00 | $1,223.00 | $4,093.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,623.62 / $3,897.35 / $6,866.21
| Professional | | $2,623.62 | $3,897.35 | $6,866.21 |