- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.83 / $2,888.50 / $7,017.02
| Facility | | $209.83 | $2,888.50 | $7,017.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.38 / $201.06 / $327.62
| Professional | | $142.38 | $201.06 | $327.62 |
- 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
- $155.02 / $217.76 / $372.40
| Professional | | $155.02 | $217.76 | $372.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,001.48 / $1,011.06 / $1,332.12
| Facility | | $1,001.48 | $1,011.06 | $1,332.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.59 / $245.28 / $415.29
| Professional | | $157.59 | $245.28 | $415.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $3,951.00 / $7,934.00
| Facility | | $1,981.00 | $3,951.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.08 / $267.10 / $450.44
| Professional | | $194.08 | $267.10 | $450.44 |