- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $3,162.28 / $9,120.11
| Facility | | $346.74 | $3,162.28 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $371.54 / $977.24
| Professional | | $173.78 | $371.54 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,754.40 / $13,489.63
| Facility | | $1,862.09 | $5,754.40 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $338.84 / $831.76
| Professional | | $208.93 | $338.84 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $891.25 / $2,511.89
| Facility | | $302.00 | $891.25 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $512.86 / $977.24
| Professional | | $229.09 | $512.86 | $977.24 |
- 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
- $316.23 / $524.81 / $977.24
| Professional | | $316.23 | $524.81 | $977.24 |