- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $2,818.38 / $8,912.51
| Facility | | $234.42 | $2,818.38 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $199.53 / $371.54
| Professional | | $114.82 | $199.53 | $371.54 |
- 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
- $112.20 / $186.21 / $371.54
| Professional | | $112.20 | $186.21 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $524.81 / $1,949.84
| Facility | | $204.17 | $524.81 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $218.78 / $489.78
| Professional | | $123.03 | $218.78 | $489.78 |
- 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
- $107.15 / $186.21 / $346.74
| Professional | | $107.15 | $186.21 | $346.74 |