- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $3,388.44 / $9,120.11
| Facility | | $562.34 | $3,388.44 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $354.81 / $707.95
| Professional | | $229.09 | $354.81 | $707.95 |
- 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
- $181.97 / $288.40 / $616.60
| Professional | | $181.97 | $288.40 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $977.24 / $2,570.40
| Facility | | $501.19 | $977.24 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $380.19 / $831.76
| Professional | | $229.09 | $380.19 | $831.76 |
- 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
- $204.17 / $323.59 / $616.60
| Professional | | $204.17 | $323.59 | $616.60 |