- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $3,162.28 / $8,912.51
| Facility | | $537.03 | $3,162.28 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $112.20 / $257.04
| Professional | | $93.33 | $112.20 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $4,073.80 / $10,000.00
| Facility | | $1,412.54 | $4,073.80 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $120.23 / $223.87
| Professional | | $83.18 | $120.23 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $537.03 / $2,511.89
| Facility | | $177.83 | $537.03 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $147.91 / $331.13
| Professional | | $91.20 | $147.91 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,981.07 / $9,549.93
| Facility | | $1,047.13 | $3,981.07 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $117.49 / $213.80
| Professional | | $83.18 | $117.49 | $213.80 |