- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $2,884.03 / $8,912.51
| Facility | | $288.40 | $2,884.03 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $229.09 / $436.52
| Professional | | $138.04 | $229.09 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,168.69 / $10,000.00
| Facility | | $1,513.56 | $4,168.69 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $239.88 / $436.52
| Professional | | $141.25 | $239.88 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $275.42 / $933.25
| Facility | | $158.49 | $275.42 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $263.03 / $537.03
| Professional | | $154.88 | $263.03 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,691.53 / $6,606.93
| Facility | | $645.65 | $2,691.53 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $223.87 / $407.38
| Professional | | $134.90 | $223.87 | $407.38 |