- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $3,235.94 / $9,120.11
| Facility | | $263.03 | $3,235.94 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $234.42 / $537.03
| Professional | | $169.82 | $234.42 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,248.07 / $11,220.18
| Facility | | $2,089.30 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $275.42 / $489.78
| Professional | | $181.97 | $275.42 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $724.44 / $2,187.76
| Facility | | $229.09 | $724.44 | $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
- $169.82 / $245.47 / $457.09
| Professional | | $169.82 | $245.47 | $457.09 |