- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $260.53 / $2,762.93 / $7,208.50
| Facility | | $260.53 | $2,762.93 | $7,208.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.57 / $215.42 / $421.47
| Professional | | $116.57 | $215.42 | $421.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,234.00 / $3,931.00 / $7,344.00
| Facility | | $2,234.00 | $3,931.00 | $7,344.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.43 / $252.33 / $439.58
| Professional | | $141.43 | $252.33 | $439.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $826.46 / $910.22 / $1,216.12
| Facility | | $826.46 | $910.22 | $1,216.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.69 / $261.68 / $513.89
| Professional | | $138.69 | $261.68 | $513.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,218.00 / $5,606.00
| Facility | | $1,640.00 | $3,218.00 | $5,606.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.06 / $338.36 / $599.19
| Professional | | $234.06 | $338.36 | $599.19 |