- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.28 / $1,905.46 / $10,000.00
| Facility | | $81.28 | $1,905.46 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $120.23 / $436.52
| Professional | | $45.71 | $120.23 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,715.35 / $9,549.93
| Facility | | $1,513.56 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $91.20 / $208.93
| Professional | | $48.98 | $91.20 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.48 / $199.53 / $912.01
| Facility | | $52.48 | $199.53 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $112.20 / $269.15
| Professional | | $52.48 | $112.20 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $1,071.52 / $3,467.37
| Facility | | $213.80 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $91.20 / $190.55
| Professional | | $45.71 | $91.20 | $190.55 |