- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $3,162.28 / $9,120.11
| Facility | | $537.03 | $3,162.28 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $213.80 / $691.83
| Professional | | $173.78 | $213.80 | $691.83 |
- 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
- $173.78 / $269.15 / $478.63
| Professional | | $173.78 | $269.15 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $741.31 / $1,778.28
| Facility | | $338.84 | $741.31 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $309.03 / $645.65
| Professional | | $194.98 | $309.03 | $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
- $173.78 / $245.47 / $446.68
| Professional | | $173.78 | $245.47 | $446.68 |