- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $2,691.53 / $8,511.38
| Facility | | $213.80 | $2,691.53 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $177.83 / $389.05
| Professional | | $138.04 | $177.83 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,265.80 / $10,000.00
| Facility | | $1,584.89 | $4,265.80 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $218.78 / $380.19
| Professional | | $144.54 | $218.78 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $676.08 / $1,778.28
| Facility | | $257.04 | $676.08 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $234.42 / $512.86
| Professional | | $151.36 | $234.42 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,265.80 / $10,000.00
| Facility | | $1,584.89 | $4,265.80 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $190.55 / $354.81
| Professional | | $131.83 | $190.55 | $354.81 |