- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $3,801.89 / $10,715.19
| Facility | | $467.74 | $3,801.89 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $389.05 / $758.58
| Professional | | $251.19 | $389.05 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $6,025.60 / $13,489.63
| Facility | | $2,630.27 | $6,025.60 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $380.19 / $724.44
| Professional | | $213.80 | $380.19 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $1,445.44 / $3,235.94
| Facility | | $457.09 | $1,445.44 | $3,235.94 |
- 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
- $251.19 / $407.38 / $758.58
| Professional | | $251.19 | $407.38 | $758.58 |