- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $3,715.35 / $9,772.37
| Facility | | $660.69 | $3,715.35 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $134.90 / $338.84
| Professional | | $114.82 | $134.90 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,011.87 / $10,964.78
| Facility | | $1,819.70 | $5,011.87 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $177.83 / $338.84
| Professional | | $114.82 | $177.83 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $416.87 / $1,659.59
| Facility | | $186.21 | $416.87 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $199.53 / $436.52
| Professional | | $128.82 | $199.53 | $436.52 |
- 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
- $107.15 / $151.36 / $288.40
| Professional | | $107.15 | $151.36 | $288.40 |