- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $2,884.03 / $9,120.11
| Facility | | $389.05 | $2,884.03 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $288.40 / $616.60
| Professional | | $199.53 | $288.40 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,466.84 / $10,000.00
| Facility | | $1,584.89 | $4,466.84 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $295.12 / $588.84
| Professional | | $204.17 | $295.12 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $812.83 / $11,481.54
| Facility | | $151.36 | $812.83 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $346.74 / $794.33
| Professional | | $208.93 | $346.74 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,862.09 / $4,677.35
| Facility | | $467.74 | $1,862.09 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $288.40 / $524.81
| Professional | | $190.55 | $288.40 | $524.81 |