- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $5,370.32 / $7,079.46
| Facility | | $436.52 | $5,370.32 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $436.52 / $1,000.00
| Professional | | $302.00 | $436.52 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $2,570.40 / $6,456.54
| Professional | | $416.87 | $2,570.40 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $489.78 / $977.24
| Professional | | $380.19 | $489.78 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $478.63 / $1,023.29
| Professional | | $457.09 | $478.63 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $13,489.63 / $26,302.68
| Facility | | $2,344.23 | $13,489.63 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $478.63 / $1,000.00
| Professional | | $323.59 | $478.63 | $1,000.00 |