- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $4,677.35 / $11,220.18
| Facility | | $812.83 | $4,677.35 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $363.08 / $851.14
| Professional | | $288.40 | $363.08 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,248.07 / $10,964.78
| Facility | | $1,949.84 | $5,248.07 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $407.38 / $794.33
| Professional | | $281.84 | $407.38 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,047.13 / $2,570.40
| Facility | | $537.03 | $1,047.13 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $467.74 / $1,023.29
| Professional | | $309.03 | $467.74 | $1,023.29 |
- 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
- $257.04 / $363.08 / $691.83
| Professional | | $257.04 | $363.08 | $691.83 |