- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $2,691.53 / $8,511.38
| Facility | | $346.74 | $2,691.53 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $331.13 / $776.25
| Professional | | $138.04 | $331.13 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $5,011.87 / $10,964.78
| Facility | | $1,698.24 | $5,011.87 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $234.42 / $549.54
| Professional | | $131.83 | $234.42 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $794.33 / $2,691.53
| Facility | | $245.47 | $794.33 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $380.19 / $851.14
| Professional | | $162.18 | $380.19 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,884.03 / $6,309.57
| Facility | | $1,000.00 | $2,884.03 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $316.23 / $676.08
| Professional | | $134.90 | $316.23 | $676.08 |