- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $2,818.38 / $8,912.51
| Facility | | $363.08 | $2,818.38 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $251.19 / $524.81
| Professional | | $208.93 | $251.19 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,168.69 / $10,000.00
| Facility | | $1,548.82 | $4,168.69 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $281.84 / $562.34
| Professional | | $190.55 | $281.84 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $660.69 / $1,862.09
| Facility | | $257.04 | $660.69 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $331.13 / $741.31
| Professional | | $223.87 | $331.13 | $741.31 |
- 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
- $190.55 / $269.15 / $512.86
| Professional | | $190.55 | $269.15 | $512.86 |