- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.71 / $3,064.00 / $4,707.00
| Facility | | $134.71 | $3,064.00 | $4,707.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.34 / $135.44 / $147.88
| Professional | | $114.34 | $135.44 | $147.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $45.00 / $60.00
| Professional | | $30.00 | $45.00 | $60.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,393.93 / $7,261.43 / $10,581.98
| Facility | | $3,393.93 | $7,261.43 | $10,581.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.26 / $167.37 / $175.36
| Professional | | $142.26 | $167.37 | $175.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $871.00 / $4,515.00 / $7,609.06
| Facility | | $871.00 | $4,515.00 | $7,609.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.85 / $185.40 / $305.69
| Professional | | $130.85 | $185.40 | $305.69 |