- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $2,818.38 / $8,912.51
| Facility | | $380.19 | $2,818.38 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $295.12 / $588.84
| Professional | | $186.21 | $295.12 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,168.69 / $10,000.00
| Facility | | $1,584.89 | $4,168.69 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $316.23 / $645.65
| Professional | | $165.96 | $316.23 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $1,230.27 / $3,019.95
| Facility | | $354.81 | $1,230.27 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $380.19 / $870.96
| Professional | | $208.93 | $380.19 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,951.21 / $6,760.83
| Facility | | $1,023.29 | $2,951.21 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $309.03 / $616.60
| Professional | | $186.21 | $309.03 | $616.60 |