- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $2,344.23 / $8,511.38
| Facility | | $741.31 | $2,344.23 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $524.81 / $5,370.32
| Professional | | $147.91 | $524.81 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,623.41 / $6,760.83
| Facility | | $5,011.87 | $5,623.41 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $11,220.18 / $14,125.38
| Facility | | $5,370.32 | $11,220.18 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $199.53 / $346.74
| Professional | | $120.23 | $199.53 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,630.78 / $7,585.78
| Facility | | $1,288.25 | $3,630.78 | $7,585.78 |