- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $3,235.94 / $8,912.51
| Facility | | $323.59 | $3,235.94 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $275.42 / $588.84
| Professional | | $147.91 | $275.42 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,128.61 / $10,964.78
| Facility | | $1,819.70 | $5,128.61 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $245.47 / $478.63
| Professional | | $144.54 | $245.47 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $724.44 / $2,290.87
| Facility | | $251.19 | $724.44 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $323.59 / $707.95
| Professional | | $169.82 | $323.59 | $707.95 |
- 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
- $144.54 / $263.03 / $524.81
| Professional | | $144.54 | $263.03 | $524.81 |