- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.14 / $1,313.00 / $3,109.00
| Facility | | $320.14 | $1,313.00 | $3,109.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.26 / $975.00 / $2,417.86
| Professional | | $217.26 | $975.00 | $2,417.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.47 / $259.51 / $2,324.25
| Professional | | $176.47 | $259.51 | $2,324.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.62 / $443.60 / $3,330.51
| Professional | | $281.62 | $443.60 | $3,330.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.00 / $337.00 / $858.00
| Facility | | $130.00 | $337.00 | $858.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,567.29 / $1,950.64 / $3,387.11
| Professional | | $1,567.29 | $1,950.64 | $3,387.11 |