- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $2,754.23 / $8,511.38
| Facility | | $446.68 | $2,754.23 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $389.05 / $741.31
| Professional | | $239.88 | $389.05 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,570.88 / $13,489.63
| Facility | | $1,621.81 | $4,570.88 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $380.19 / $707.95
| Professional | | $204.17 | $380.19 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $1,318.26 / $3,715.35
| Facility | | $457.09 | $1,318.26 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $467.74 / $1,047.13
| Professional | | $281.84 | $467.74 | $1,047.13 |
- 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
- $239.88 / $398.11 / $758.58
| Professional | | $239.88 | $398.11 | $758.58 |