- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $4,897.79 / $11,481.54
| Facility | | $954.99 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $416.87 / $912.01
| Professional | | $354.81 | $416.87 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $7,585.78 / $14,791.08
| Facility | | $2,630.27 | $7,585.78 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $512.86 / $977.24
| Professional | | $346.74 | $512.86 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,148.15 / $2,951.21
| Facility | | $616.60 | $1,148.15 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $588.84 / $1,258.93
| Professional | | $380.19 | $588.84 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,884.03 / $6,456.54
| Facility | | $1,000.00 | $2,884.03 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $467.74 / $851.14
| Professional | | $323.59 | $467.74 | $851.14 |