- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.86 / $3,780.50 / $8,373.50
| Facility | | $199.86 | $3,780.50 | $8,373.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.72 / $189.43 / $234.16
| Professional | | $153.72 | $189.43 | $234.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.10 / $5,977.00 / $11,136.00
| Facility | | $3,302.10 | $5,977.00 | $11,136.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.34 / $360.77 / $596.46
| Professional | | $272.34 | $360.77 | $596.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $205.15 / $209.32 / $602.85
| Facility | | $205.15 | $209.32 | $602.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.55 / $435.81 / $616.75
| Professional | | $396.55 | $435.81 | $616.75 |
- 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
- $249.91 / $339.70 / $551.42
| Professional | | $249.91 | $339.70 | $551.42 |