- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $3,235.94 / $8,912.51
| Facility | | $436.52 | $3,235.94 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $363.08 / $891.25
| Professional | | $275.42 | $363.08 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,754.40 / $13,489.63
| Facility | | $1,995.26 | $5,754.40 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $398.11 / $758.58
| Professional | | $288.40 | $398.11 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,380.38 / $3,388.44
| Facility | | $537.03 | $1,380.38 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $457.09 / $1,000.00
| Professional | | $302.00 | $457.09 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,265.80 / $9,772.37
| Facility | | $1,584.89 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $389.05 / $724.44
| Professional | | $269.15 | $389.05 | $724.44 |