- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $3,981.07 / $10,715.19
| Facility | | $524.81 | $3,981.07 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $398.11 / $776.25
| Professional | | $263.03 | $398.11 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,888.44 / $13,489.63
| Facility | | $2,089.30 | $5,888.44 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $398.11 / $758.58
| Professional | | $223.87 | $398.11 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $1,122.02 / $3,090.30
| Facility | | $446.68 | $1,122.02 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $501.19 / $1,071.52
| Professional | | $302.00 | $501.19 | $1,071.52 |
- 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
- $263.03 / $416.87 / $794.33
| Professional | | $263.03 | $416.87 | $794.33 |