- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.79 / $5,063.00 / $7,631.00
| Facility | | $105.79 | $5,063.00 | $7,631.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.65 / $101.48 / $111.52
| Professional | | $98.65 | $101.48 | $111.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,066.27 / $2,945.52 / $6,552.00
| Facility | | $1,066.27 | $2,945.52 | $6,552.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.02 / $108.02 / $212.01
| Professional | | $108.02 | $108.02 | $212.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.52 / $143.52 / $143.52
| Professional | | $143.52 | $143.52 | $143.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $4,886.00 / $7,889.00
| Facility | | $1,200.00 | $4,886.00 | $7,889.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.40 / $168.32 / $261.49
| Professional | | $118.40 | $168.32 | $261.49 |