- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $3,630.78 / $8,912.51
| Facility | | $602.56 | $3,630.78 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $616.60 / $1,698.24
| Professional | | $309.03 | $616.60 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $6,025.60 / $12,302.69
| Facility | | $2,041.74 | $6,025.60 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $501.19 / $954.99
| Professional | | $295.12 | $501.19 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,862.09 / $4,677.35
| Facility | | $537.03 | $1,862.09 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $645.65 / $1,445.44
| Professional | | $338.84 | $645.65 | $1,445.44 |
- 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
- $288.40 / $537.03 / $1,047.13
| Professional | | $288.40 | $537.03 | $1,047.13 |