- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $3,801.89 / $8,912.51
| Facility | | $371.54 | $3,801.89 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $363.08 / $1,047.13
| Professional | | $239.88 | $363.08 | $1,047.13 |
- 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
- $239.88 / $380.19 / $676.08
| Professional | | $239.88 | $380.19 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $891.25 / $2,398.83
| Facility | | $309.03 | $891.25 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $398.11 / $870.96
| Professional | | $257.04 | $398.11 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,365.16 / $10,000.00
| Facility | | $1,584.89 | $4,365.16 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $331.13 / $602.56
| Professional | | $229.09 | $331.13 | $602.56 |