- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $3,388.44 / $9,120.11
| Facility | | $549.54 | $3,388.44 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $446.68 / $851.14
| Professional | | $288.40 | $446.68 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,365.16 / $10,000.00
| Facility | | $1,995.26 | $4,365.16 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $446.68 / $812.83
| Professional | | $251.19 | $446.68 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,445.44 / $3,467.37
| Facility | | $524.81 | $1,445.44 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $549.54 / $1,174.90
| Professional | | $331.13 | $549.54 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $4,073.80 / $9,549.93
| Facility | | $1,348.96 | $4,073.80 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $446.68 / $851.14
| Professional | | $281.84 | $446.68 | $851.14 |