- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.49 / $408.53 / $2,439.88
| Professional | | $198.49 | $408.53 | $2,439.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $692.99 / $11,500.00 / $12,000.00
| Facility | | $692.99 | $11,500.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $952.00 / $3,174.88 / $3,174.88
| Professional | | $952.00 | $3,174.88 | $3,174.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.34 / $524.50 / $1,111.00
| Facility | | $123.34 | $524.50 | $1,111.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $451.40 / $1,101.00
| Professional | | $4.00 | $451.40 | $1,101.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.34 / $524.50 / $1,111.00
| Facility | | $123.34 | $524.50 | $1,111.00 |