- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $2,818.38 / $8,912.51
| Facility | | $501.19 | $2,818.38 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $380.19 / $776.25
| Professional | | $309.03 | $380.19 | $776.25 |
- 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
- $229.09 / $389.05 / $794.33
| Professional | | $229.09 | $389.05 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,318.26 / $3,467.37
| Facility | | $588.84 | $1,318.26 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $489.78 / $1,096.48
| Professional | | $331.13 | $489.78 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,951.21 / $6,918.31
| Facility | | $1,000.00 | $2,951.21 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $398.11 / $758.58
| Professional | | $281.84 | $398.11 | $758.58 |