- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $5,128.61 / $9,772.37
| Facility | | $1,258.93 | $5,128.61 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $223.87 / $575.44
| Professional | | $47.86 | $223.87 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $12,022.64 / $14,125.38
| Facility | | $10,232.93 | $12,022.64 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $199.53 / $346.74
| Professional | | $120.23 | $199.53 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $7,244.36 / $21,877.62
| Facility | | $2,570.40 | $7,244.36 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $79.43 / $151.36
| Professional | | $52.48 | $79.43 | $151.36 |