- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $3,311.31 / $8,912.51
| Facility | | $407.38 | $3,311.31 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $234.42 / $724.44
| Professional | | $177.83 | $234.42 | $724.44 |
- 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
- $181.97 / $257.04 / $478.63
| Professional | | $181.97 | $257.04 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $741.31 / $2,041.74
| Facility | | $338.84 | $741.31 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $302.00 / $645.65
| Professional | | $190.55 | $302.00 | $645.65 |
- 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
- $169.82 / $239.88 / $446.68
| Professional | | $169.82 | $239.88 | $446.68 |