- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $2,818.38 / $8,912.51
| Facility | | $478.63 | $2,818.38 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $398.11 / $758.58
| Professional | | $223.87 | $398.11 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $4,570.88 / $10,000.00
| Facility | | $1,737.80 | $4,570.88 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $371.54 / $707.95
| Professional | | $223.87 | $371.54 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $1,318.26 / $3,311.31
| Facility | | $416.87 | $1,318.26 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $489.78 / $1,047.13
| Professional | | $257.04 | $489.78 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,949.84 / $4,677.35
| Facility | | $645.65 | $1,949.84 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $407.38 / $794.33
| Professional | | $218.78 | $407.38 | $794.33 |