- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $4,677.35 / $10,471.29
| Facility | | $316.23 | $4,677.35 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $177.83 / $346.74
| Professional | | $151.36 | $177.83 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,818.38 / $6,456.54
| Facility | | $2,398.83 | $2,818.38 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $323.59 / $436.52
| Professional | | $158.49 | $323.59 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $263.03 / $537.03
| Professional | | $173.78 | $263.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $257.04 / $309.03
| Professional | | $194.98 | $257.04 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $3,162.28 / $6,760.83
| Facility | | $354.81 | $3,162.28 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $213.80 / $489.78
| Professional | | $151.36 | $213.80 | $489.78 |