- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $2,818.38 / $8,912.51
| Facility | | $288.40 | $2,818.38 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $223.87 / $478.63
| Professional | | $165.96 | $223.87 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $4,365.16 / $10,000.00
| Facility | | $1,905.46 | $4,365.16 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $281.84 / $489.78
| Professional | | $186.21 | $281.84 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $912.01 / $2,187.76
| Facility | | $316.23 | $912.01 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $295.12 / $660.69
| Professional | | $190.55 | $295.12 | $660.69 |
- 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
- $165.96 / $245.47 / $457.09
| Professional | | $165.96 | $245.47 | $457.09 |