- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $248.14 / $1,803.35 / $6,838.50
| Facility | | $248.14 | $1,803.35 | $6,838.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.31 / $234.93 / $404.63
| Professional | | $134.31 | $234.93 | $404.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,248.00 / $4,589.00 / $10,404.00
| Facility | | $3,248.00 | $4,589.00 | $10,404.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.78 / $202.57 / $322.16
| Professional | | $142.78 | $202.57 | $322.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $466.83 / $858.80 / $2,065.96
| Facility | | $466.83 | $858.80 | $2,065.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.18 / $284.57 / $532.57
| Professional | | $168.18 | $284.57 | $532.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.00 / $5,111.00 / $9,202.00
| Facility | | $2,200.00 | $5,111.00 | $9,202.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.14 / $377.57 / $622.13
| Professional | | $230.14 | $377.57 | $622.13 |