- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $1,288.25 / $3,890.45
| Facility | | $213.80 | $1,288.25 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $204.17 / $309.03
| Professional | | $100.00 | $204.17 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,137.96 / $2,951.21
| Facility | | $1,348.96 | $2,137.96 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $154.88 / $218.78
| Professional | | $97.72 | $154.88 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $112.20 / $158.49
| Facility | | $91.20 | $112.20 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $123.03 / $158.49
| Professional | | $87.10 | $123.03 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $181.97 / $1,318.26
| Facility | | $181.97 | $181.97 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $218.78 / $1,047.13
| Professional | | $107.15 | $218.78 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $251.19
| Professional | | $32.36 | $33.11 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,348.96 / $5,248.07
| Facility | | $524.81 | $1,348.96 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $181.97 / $316.23
| Professional | | $100.00 | $181.97 | $316.23 |