- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $3,715.35 / $9,549.93
| Facility | | $954.99 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $676.08 / $1,479.11
| Professional | | $562.34 | $676.08 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,248.07 / $10,964.78
| Facility | | $2,089.30 | $5,248.07 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $794.33 / $1,513.56
| Professional | | $512.86 | $794.33 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,621.81 / $4,897.79
| Facility | | $724.44 | $1,621.81 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $912.01 / $2,041.74
| Professional | | $602.56 | $912.01 | $2,041.74 |
- 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
- $501.19 / $724.44 / $1,348.96
| Professional | | $501.19 | $724.44 | $1,348.96 |