- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $193.43 / $1,223.00 / $2,250.00
| Facility | | $193.43 | $1,223.00 | $2,250.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.22 / $165.65 / $207.13
| Professional | | $126.22 | $165.65 | $207.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,607.25 / $3,164.02 / $4,256.62
| Facility | | $2,607.25 | $3,164.02 | $4,256.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.51 / $193.45 / $265.00
| Professional | | $136.51 | $193.45 | $265.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.33 / $175.76 / $411.98
| Professional | | $116.33 | $175.76 | $411.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.00 / $850.00 / $1,323.00
| Facility | | $241.00 | $850.00 | $1,323.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.25 / $196.30 / $235.47
| Professional | | $160.25 | $196.30 | $235.47 |