- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $3,388.44 / $6,025.60
| Facility | | $173.78 | $3,388.44 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $630.96 / $954.99
| Professional | | $173.78 | $630.96 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $44.67 / $60.26
| Professional | | $32.36 | $44.67 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $3,090.30 / $3,311.31
| Professional | | $645.65 | $3,090.30 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $602.56 / $912.01
| Professional | | $177.83 | $602.56 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,128.61 / $13,803.84
| Facility | | $2,290.87 | $5,128.61 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $776.25 / $1,230.27
| Professional | | $588.84 | $776.25 | $1,230.27 |