- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $3,090.30 / $8,511.38
| Facility | | $257.04 | $3,090.30 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $251.19 / $501.19
| Professional | | $131.83 | $251.19 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,265.80 / $10,000.00
| Facility | | $1,621.81 | $4,265.80 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $234.42 / $446.68
| Professional | | $123.03 | $234.42 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $295.12 / $1,096.48
| Facility | | $158.49 | $295.12 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $275.42 / $575.44
| Professional | | $141.25 | $275.42 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,630.27 / $6,309.57
| Facility | | $645.65 | $2,630.27 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $223.87 / $426.58
| Professional | | $120.23 | $223.87 | $426.58 |