- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $4,677.35 / $10,964.78
| Facility | | $1,174.90 | $4,677.35 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $190.55 / $234.42
| Professional | | $128.82 | $190.55 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $4,365.16 / $10,471.29
| Facility | | $2,089.30 | $4,365.16 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $204.17 / $562.34
| Professional | | $125.89 | $204.17 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $912.01 / $2,511.89
| Facility | | $371.54 | $912.01 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $346.74 / $398.11
| Professional | | $316.23 | $346.74 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,884.03 / $6,309.57
| Facility | | $1,000.00 | $2,884.03 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $245.47 / $501.19
| Professional | | $162.18 | $245.47 | $501.19 |