- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $4,466.84 / $10,964.78
| Facility | | $977.24 | $4,466.84 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $602.56 / $1,348.96
| Professional | | $512.86 | $602.56 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $6,165.95 / $13,803.84
| Facility | | $2,691.53 | $6,165.95 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $724.44 / $1,412.54
| Professional | | $489.78 | $724.44 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,819.70 / $4,168.69
| Facility | | $1,000.00 | $1,819.70 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $831.76 / $1,819.70
| Professional | | $562.34 | $831.76 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,265.80 / $10,000.00
| Facility | | $1,513.56 | $4,265.80 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $660.69 / $1,258.93
| Professional | | $478.63 | $660.69 | $1,258.93 |