- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $2,818.38 / $8,912.51
| Facility | | $288.40 | $2,818.38 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $281.84 / $676.08
| Professional | | $131.83 | $281.84 | $676.08 |
- 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
- $125.89 / $251.19 / $501.19
| Professional | | $125.89 | $251.19 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $602.56 / $2,344.23
| Facility | | $234.42 | $602.56 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $295.12 / $645.65
| Professional | | $144.54 | $295.12 | $645.65 |
- 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
- $123.03 / $239.88 / $467.74
| Professional | | $123.03 | $239.88 | $467.74 |