- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $3,388.44 / $9,120.11
| Facility | | $512.86 | $3,388.44 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $380.19 / $741.31
| Professional | | $245.47 | $380.19 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,897.79 / $13,489.63
| Facility | | $2,238.72 | $4,897.79 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $398.11 / $724.44
| Professional | | $223.87 | $398.11 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,047.13 / $2,951.21
| Facility | | $436.52 | $1,047.13 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $489.78 / $1,023.29
| Professional | | $288.40 | $489.78 | $1,023.29 |
- 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
- $257.04 / $426.58 / $794.33
| Professional | | $257.04 | $426.58 | $794.33 |