- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $513.52 / $2,762.93 / $7,288.50
| Facility | | $513.52 | $2,762.93 | $7,288.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.82 / $450.80 / $841.52
| Professional | | $301.82 | $450.80 | $841.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,263.00 / $5,196.00 / $10,517.23
| Facility | | $3,263.00 | $5,196.00 | $10,517.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.02 / $514.05 / $797.33
| Professional | | $337.02 | $514.05 | $797.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $607.88 / $1,052.00 / $1,598.87
| Facility | | $607.88 | $1,052.00 | $1,598.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.59 / $553.28 / $977.24
| Professional | | $358.59 | $553.28 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,967.50 / $4,044.50 / $8,138.00
| Facility | | $1,967.50 | $4,044.50 | $8,138.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.34 / $591.42 / $1,090.38
| Professional | | $434.34 | $591.42 | $1,090.38 |