- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $4,073.80 / $9,332.54
| Facility | | $524.81 | $4,073.80 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $281.84 / $851.14
| Professional | | $186.21 | $281.84 | $851.14 |
- 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
- $165.96 / $275.42 / $512.86
| Professional | | $165.96 | $275.42 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $616.60 / $1,698.24
| Facility | | $295.12 | $616.60 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $309.03 / $660.69
| Professional | | $194.98 | $309.03 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,265.80 / $9,549.93
| Facility | | $1,513.56 | $4,265.80 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $245.47 / $457.09
| Professional | | $173.78 | $245.47 | $457.09 |