- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $3,890.45 / $10,471.29
| Facility | | $588.84 | $3,890.45 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $489.78 / $977.24
| Professional | | $302.00 | $489.78 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $7,079.46 / $14,454.40
| Facility | | $2,818.38 | $7,079.46 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $467.74 / $891.25
| Professional | | $257.04 | $467.74 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,778.28 / $4,073.80
| Facility | | $602.56 | $1,778.28 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $602.56 / $1,318.26
| Professional | | $354.81 | $602.56 | $1,318.26 |
- 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
- $295.12 / $489.78 / $933.25
| Professional | | $295.12 | $489.78 | $933.25 |