- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $3,715.35 / $9,549.93
| Facility | | $776.25 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $467.74 / $1,148.15
| Professional | | $398.11 | $467.74 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,888.44 / $13,489.63
| Facility | | $2,290.87 | $5,888.44 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $562.34 / $1,071.52
| Professional | | $380.19 | $562.34 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,584.89 / $3,715.35
| Facility | | $776.25 | $1,584.89 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $645.65 / $1,445.44
| Professional | | $436.52 | $645.65 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,951.21 / $6,918.31
| Facility | | $1,000.00 | $2,951.21 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $512.86 / $954.99
| Professional | | $363.08 | $512.86 | $954.99 |