- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $3,090.30 / $8,912.51
| Facility | | $407.38 | $3,090.30 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $87.10 / $257.04
| Professional | | $72.44 | $87.10 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,168.69 / $10,000.00
| Facility | | $1,584.89 | $4,168.69 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $104.71 / $199.53
| Professional | | $70.79 | $104.71 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $281.84 / $1,318.26
| Facility | | $131.83 | $281.84 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $128.82 / $288.40
| Professional | | $81.28 | $128.82 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,884.03 / $6,456.54
| Facility | | $1,023.29 | $2,884.03 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $100.00 / $181.97
| Professional | | $69.18 | $100.00 | $181.97 |