- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $3,235.94 / $8,511.38
| Facility | | $457.09 | $3,235.94 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $467.74 / $1,412.54
| Professional | | $288.40 | $467.74 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,128.61 / $10,964.78
| Facility | | $1,819.70 | $5,128.61 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $436.52 / $794.33
| Professional | | $275.42 | $436.52 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $851.14 / $3,162.28
| Facility | | $446.68 | $851.14 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $512.86 / $1,096.48
| Professional | | $316.23 | $512.86 | $1,096.48 |
- 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
- $281.84 / $426.58 / $812.83
| Professional | | $281.84 | $426.58 | $812.83 |