- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $3,311.31 / $9,549.93
| Facility | | $251.19 | $3,311.31 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $208.93 / $446.68
| Professional | | $158.49 | $208.93 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,128.61 / $11,220.18
| Facility | | $1,819.70 | $5,128.61 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $257.04 / $457.09
| Professional | | $154.88 | $257.04 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $676.08 / $2,041.74
| Facility | | $208.93 | $676.08 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $275.42 / $616.60
| Professional | | $173.78 | $275.42 | $616.60 |
- 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
- $154.88 / $229.09 / $426.58
| Professional | | $154.88 | $229.09 | $426.58 |