- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $1,819.70 / $2,818.38
| Facility | | $190.55 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $257.04 / $478.63
| Professional | | $213.80 | $257.04 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $588.84
| Professional | | $588.84 | $588.84 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $389.05 / $537.03
| Professional | | $251.19 | $389.05 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,659.59 / $5,370.32
| Facility | | $724.44 | $1,659.59 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $331.13 / $602.56
| Professional | | $257.04 | $331.13 | $602.56 |