- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $3,162.28 / $8,912.51
| Facility | | $537.03 | $3,162.28 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $309.03 / $724.44
| Professional | | $251.19 | $309.03 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,570.88 / $10,471.29
| Facility | | $2,238.72 | $4,570.88 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $389.05 / $707.95
| Professional | | $234.42 | $389.05 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $977.24 / $2,454.71
| Facility | | $457.09 | $977.24 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $436.52 / $933.25
| Professional | | $281.84 | $436.52 | $933.25 |
- 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
- $251.19 / $354.81 / $645.65
| Professional | | $251.19 | $354.81 | $645.65 |