- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $3,388.44 / $8,511.38
| Facility | | $239.88 | $3,388.44 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $323.59 / $912.01
| Professional | | $151.36 | $323.59 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $6,456.54 / $10,964.78
| Facility | | $3,467.37 | $6,456.54 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $346.74 / $616.60
| Professional | | $177.83 | $346.74 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $331.13 / $602.56
| Professional | | $190.55 | $331.13 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $446.68 / $1,000.00
| Professional | | $190.55 | $446.68 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $316.23 / $323.59
| Professional | | $138.04 | $316.23 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $4,168.69 / $7,079.46
| Facility | | $1,479.11 | $4,168.69 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $363.08 / $645.65
| Professional | | $190.55 | $363.08 | $645.65 |