- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $4,365.16 / $10,715.19
| Facility | | $707.95 | $4,365.16 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $186.21 / $446.68
| Professional | | $162.18 | $186.21 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $6,025.60 / $13,489.63
| Facility | | $2,630.27 | $6,025.60 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $234.42 / $457.09
| Professional | | $147.91 | $234.42 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $562.34 / $1,862.09
| Facility | | $295.12 | $562.34 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $281.84 / $575.44
| Professional | | $177.83 | $281.84 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,265.80 / $10,000.00
| Facility | | $1,513.56 | $4,265.80 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $218.78 / $426.58
| Professional | | $147.91 | $218.78 | $426.58 |