- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,284.38 / $9,825.93 / $27,769.45
| Facility | | $1,284.38 | $9,825.93 | $27,769.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $443.62 / $714.24 / $839.39
| Professional | | $443.62 | $714.24 | $839.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,862.88 / $4,862.88 / $4,862.88
| Facility | | $4,862.88 | $4,862.88 | $4,862.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.82 / $695.43 / $1,326.47
| Professional | | $500.82 | $695.43 | $1,326.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,153.97 / $19,403.18 / $19,698.95
| Facility | | $5,153.97 | $19,403.18 | $19,698.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.92 / $508.92 / $1,084.49
| Professional | | $508.92 | $508.92 | $1,084.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.00 / $2,200.00 / $2,200.00
| Facility | | $2,200.00 | $2,200.00 | $2,200.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.25 / $757.89 / $1,928.60
| Professional | | $602.25 | $757.89 | $1,928.60 |