- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $3,235.94 / $8,912.51
| Facility | | $407.38 | $3,235.94 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $380.19 / $891.25
| Professional | | $245.47 | $380.19 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,128.61 / $10,964.78
| Facility | | $1,819.70 | $5,128.61 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $363.08 / $691.83
| Professional | | $208.93 | $363.08 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $851.14 / $2,884.03
| Facility | | $398.11 | $851.14 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $457.09 / $977.24
| Professional | | $275.42 | $457.09 | $977.24 |
- 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
- $239.88 / $380.19 / $724.44
| Professional | | $239.88 | $380.19 | $724.44 |