- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $3,548.13 / $9,332.54
| Facility | | $537.03 | $3,548.13 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $380.19 / $794.33
| Professional | | $229.09 | $380.19 | $794.33 |
- 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
- $204.17 / $363.08 / $676.08
| Professional | | $204.17 | $363.08 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $1,230.27 / $2,818.38
| Facility | | $512.86 | $1,230.27 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $407.38 / $912.01
| Professional | | $245.47 | $407.38 | $912.01 |
- 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
- $218.78 / $354.81 / $676.08
| Professional | | $218.78 | $354.81 | $676.08 |