- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $2,238.72 / $7,585.78
| Facility | | $234.42 | $2,238.72 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $234.42 / $512.86
| Professional | | $109.65 | $234.42 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $4,466.84 / $10,000.00
| Facility | | $1,659.59 | $4,466.84 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $204.17 / $457.09
| Professional | | $104.71 | $204.17 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $363.08 / $1,905.46
| Facility | | $131.83 | $363.08 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $263.03 / $575.44
| Professional | | $134.90 | $263.03 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,949.84 / $4,677.35
| Facility | | $588.84 | $1,949.84 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $245.47 / $467.74
| Professional | | $123.03 | $245.47 | $467.74 |