- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $4,265.80 / $10,715.19
| Facility | | $758.58 | $4,265.80 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $371.54 / $870.96
| Professional | | $302.00 | $371.54 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $4,265.80 / $10,000.00
| Facility | | $1,737.80 | $4,265.80 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $478.63 / $870.96
| Professional | | $316.23 | $478.63 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,000.00 / $2,570.40
| Facility | | $524.81 | $1,000.00 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $524.81 / $1,122.02
| Professional | | $346.74 | $524.81 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $2,041.74 / $4,897.79
| Facility | | $660.69 | $2,041.74 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $416.87 / $776.25
| Professional | | $295.12 | $416.87 | $776.25 |