- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $3,890.45 / $10,471.29
| Facility | | $588.84 | $3,890.45 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $478.63 / $977.24
| Professional | | $323.59 | $478.63 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $7,079.46 / $14,454.40
| Facility | | $2,344.23 | $7,079.46 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $467.74 / $891.25
| Professional | | $263.03 | $467.74 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,548.82 / $3,548.13
| Facility | | $602.56 | $1,548.82 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $588.84 / $1,258.93
| Professional | | $363.08 | $588.84 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,951.21 / $6,760.83
| Facility | | $1,000.00 | $2,951.21 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $489.78 / $933.25
| Professional | | $316.23 | $489.78 | $933.25 |