- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.01 / $1,049.80 / $2,166.30
| Facility | | $123.01 | $1,049.80 | $2,166.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.62 / $101.73 / $265.81
| Professional | | $76.62 | $101.73 | $265.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,361.27 / $2,361.27 / $2,361.27
| Facility | | $2,361.27 | $2,361.27 | $2,361.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.00 / $192.00 / $192.00
| Professional | | $192.00 | $192.00 | $192.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,302.41 / $2,302.41 / $6,919.52
| Facility | | $2,302.41 | $2,302.41 | $6,919.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.03 / $139.94 / $204.42
| Professional | | $94.03 | $139.94 | $204.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $3,559.00 / $8,974.00
| Facility | | $860.00 | $3,559.00 | $8,974.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.17 / $133.81 / $263.38
| Professional | | $95.17 | $133.81 | $263.38 |