- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,737.80 / $25,118.86
| Facility | | $977.24 | $1,737.80 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $562.34 / $1,258.93
| Professional | | $338.84 | $562.34 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $1,737.80
| Facility | | $1,737.80 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $512.86 / $870.96
| Professional | | $346.74 | $512.86 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $6,165.95 / $8,912.51
| Facility | | $2,691.53 | $6,165.95 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $489.78 / $794.33
| Professional | | $398.11 | $489.78 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,479.11
| Facility | | $1,000.00 | $1,000.00 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $501.19 / $812.83
| Professional | | $338.84 | $501.19 | $812.83 |