- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $5,370.32 / $10,232.93
| Facility | | $173.78 | $5,370.32 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $165.96 / $436.52
| Professional | | $85.11 | $165.96 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $186.21 / $354.81
| Professional | | $100.00 | $186.21 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $309.03 / $346.74
| Professional | | $229.09 | $309.03 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,288.25 / $2,041.74
| Facility | | $831.76 | $1,288.25 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $173.78 / $309.03
| Professional | | $77.62 | $173.78 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,884.03 / $7,762.47
| Facility | | $1,380.38 | $2,884.03 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $128.82 / $302.00
| Professional | | $57.54 | $128.82 | $302.00 |