- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.70 / $2,145.78 / $7,838.38
| Facility | | $245.70 | $2,145.78 | $7,838.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.12 / $254.09 / $391.47
| Professional | | $241.12 | $254.09 | $391.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $85.00 / $387.45
| Professional | | $60.00 | $85.00 | $387.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $94.04 / $237.84 / $391.47
| Facility | | $94.04 | $237.84 | $391.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,035.00 / $15,131.00 / $21,396.00
| Facility | | $1,035.00 | $15,131.00 | $21,396.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.16 / $385.56 / $597.23
| Professional | | $272.16 | $385.56 | $597.23 |