- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $3,090.30 / $8,511.38
| Facility | | $549.54 | $3,090.30 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $537.03 / $1,698.24
| Professional | | $309.03 | $537.03 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,011.87 / $10,964.78
| Facility | | $1,819.70 | $5,011.87 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $489.78 / $891.25
| Professional | | $295.12 | $489.78 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,023.29 / $3,890.45
| Facility | | $467.74 | $1,023.29 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $588.84 / $1,318.26
| Professional | | $346.74 | $588.84 | $1,318.26 |
- 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
- $295.12 / $489.78 / $933.25
| Professional | | $295.12 | $489.78 | $933.25 |