- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $2,398.83 / $8,912.51
| Facility | | $199.53 | $2,398.83 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $2,344.23 / $6,760.83
| Professional | | $158.49 | $2,344.23 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,623.41 / $8,912.51
| Facility | | $5,011.87 | $5,623.41 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $407.38 / $5,128.61
| Professional | | $147.91 | $407.38 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $524.81 / $7,943.28
| Professional | | $223.87 | $524.81 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $11,220.18 / $11,220.18
| Facility | | $11,220.18 | $11,220.18 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $2,818.38 / $6,456.54
| Professional | | $177.83 | $2,818.38 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $11,220.18 / $11,220.18
| Facility | | $11,220.18 | $11,220.18 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $2,818.38 / $8,317.64
| Professional | | $245.47 | $2,818.38 | $8,317.64 |