- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $5,248.07 / $9,549.93
| Facility | | $281.84 | $5,248.07 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $125.89 / $229.09
| Professional | | $81.28 | $125.89 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $15,135.61 / $16,595.87
| Facility | | $8,317.64 | $15,135.61 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $165.96 / $223.87
| Professional | | $112.20 | $165.96 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $162.18 / $309.03
| Professional | | $109.65 | $162.18 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $177.83 / $288.40
| Professional | | $177.83 | $177.83 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $8,317.64 / $8,317.64
| Facility | | $2,290.87 | $8,317.64 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $8,709.64 / $11,748.98
| Facility | | $5,754.40 | $8,709.64 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $154.88 / $309.03
| Professional | | $100.00 | $154.88 | $309.03 |