- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $3,388.44 / $9,120.11
| Facility | | $912.01 | $3,388.44 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $891.25 / $1,778.28
| Professional | | $616.60 | $891.25 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,248.07 / $10,964.78
| Facility | | $2,089.30 | $5,248.07 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $870.96 / $1,778.28
| Professional | | $407.38 | $870.96 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $2,137.96 / $7,244.36
| Facility | | $741.31 | $2,137.96 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,071.52 / $2,570.40
| Professional | | $602.56 | $1,071.52 | $2,570.40 |
- 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
- $537.03 / $831.76 / $1,698.24
| Professional | | $537.03 | $831.76 | $1,698.24 |