- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $7,413.10 / $9,772.37
| Facility | | $100.00 | $7,413.10 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $645.65 / $8,709.64
| Professional | | $173.78 | $645.65 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $7.08 / $7.08
| Professional | | $7.08 | $7.08 | $7.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $12,022.64 / $22,908.68
| Facility | | $10,964.78 | $12,022.64 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $3,630.78 / $7,943.28
| Facility | | $691.83 | $3,630.78 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $3,630.78 / $7,943.28
| Facility | | $691.83 | $3,630.78 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,388.44 / $4,168.69
| Facility | | $2,511.89 | $3,388.44 | $4,168.69 |