- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $3,981.07 / $10,715.19
| Facility | | $602.56 | $3,981.07 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $478.63 / $933.25
| Professional | | $295.12 | $478.63 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,248.07 / $11,220.18
| Facility | | $2,290.87 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $446.68 / $891.25
| Professional | | $275.42 | $446.68 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,548.82 / $3,801.89
| Facility | | $562.34 | $1,548.82 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $575.44 / $1,288.25
| Professional | | $331.13 | $575.44 | $1,288.25 |
- 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
- $288.40 / $478.63 / $933.25
| Professional | | $288.40 | $478.63 | $933.25 |