- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $3,311.31 / $8,912.51
| Facility | | $302.00 | $3,311.31 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $234.42 / $575.44
| Professional | | $117.49 | $234.42 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,265.80 / $10,000.00
| Facility | | $1,621.81 | $4,265.80 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $234.42 / $501.19
| Professional | | $125.89 | $234.42 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $977.24 / $2,454.71
| Facility | | $204.17 | $977.24 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $281.84 / $660.69
| Professional | | $138.04 | $281.84 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,884.03 / $6,309.57
| Facility | | $1,023.29 | $2,884.03 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $229.09 / $478.63
| Professional | | $114.82 | $229.09 | $478.63 |