- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,495.41 / $10,232.93
| Facility | | $1,862.09 | $5,495.41 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $512.86 / $1,737.80
| Professional | | $302.00 | $512.86 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $177.83 / $177.83
| Professional | | $177.83 | $177.83 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $575.44 / $1,348.96
| Professional | | $331.13 | $575.44 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $691.83 / $954.99
| Professional | | $489.78 | $691.83 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $5,495.41 / $8,317.64
| Facility | | $3,388.44 | $5,495.41 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $562.34 / $1,659.59
| Professional | | $288.40 | $562.34 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,128.61 / $8,511.38
| Facility | | $2,570.40 | $5,128.61 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $478.63 / $1,122.02
| Professional | | $269.15 | $478.63 | $1,122.02 |