- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.10 / $2,698.43 / $7,733.69
| Facility | | $241.10 | $2,698.43 | $7,733.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.71 / $214.87 / $406.22
| Professional | | $170.71 | $214.87 | $406.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,234.00 / $4,120.00 / $8,240.00
| Facility | | $2,234.00 | $4,120.00 | $8,240.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.07 / $263.45 / $426.58
| Professional | | $199.07 | $263.45 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,746.81 / $1,763.54 / $2,104.79
| Facility | | $1,746.81 | $1,763.54 | $2,104.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.61 / $284.31 / $480.48
| Professional | | $195.61 | $284.31 | $480.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $3,724.00 / $7,934.00
| Facility | | $1,981.00 | $3,724.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.32 / $299.04 / $490.56
| Professional | | $205.32 | $299.04 | $490.56 |