- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $4,073.80 / $10,232.93
| Facility | | $223.87 | $4,073.80 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $134.90 / $316.23
| Professional | | $93.33 | $134.90 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,570.88 / $10,232.93
| Facility | | $2,238.72 | $4,570.88 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $154.88 / $295.12
| Professional | | $109.65 | $154.88 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $380.19 / $2,290.87
| Facility | | $181.97 | $380.19 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $190.55 / $426.58
| Professional | | $120.23 | $190.55 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,365.16 / $10,000.00
| Facility | | $1,584.89 | $4,365.16 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $144.54 / $269.15
| Professional | | $100.00 | $144.54 | $269.15 |