- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $3,890.45 / $10,471.29
| Facility | | $602.56 | $3,890.45 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $478.63 / $912.01
| Professional | | $309.03 | $478.63 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $7,079.46 / $14,454.40
| Facility | | $2,818.38 | $7,079.46 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $478.63 / $870.96
| Professional | | $269.15 | $478.63 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,621.81 / $3,630.78
| Facility | | $549.54 | $1,621.81 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $575.44 / $1,230.27
| Professional | | $354.81 | $575.44 | $1,230.27 |
- 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
- $302.00 / $478.63 / $912.01
| Professional | | $302.00 | $478.63 | $912.01 |