- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.84 / $4,862.00 / $16,467.00
| Facility | | $206.84 | $4,862.00 | $16,467.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.96 / $206.84 / $944.23
| Professional | | $155.96 | $206.84 | $944.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.52 / $167.56 / $264.11
| Facility | | $92.52 | $167.56 | $264.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.84 / $227.52 / $279.23
| Facility | | $206.84 | $227.52 | $279.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Professional | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.00 / $1,221.00 / $3,585.00
| Facility | | $225.00 | $1,221.00 | $3,585.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.31 / $53.73 / $176.95
| Professional | | $43.31 | $53.73 | $176.95 |