- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,981.07 / $10,715.19
| Facility | | $398.11 | $3,981.07 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $295.12 / $616.60
| Professional | | $181.97 | $295.12 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $6,025.60 / $13,489.63
| Facility | | $2,630.27 | $6,025.60 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $309.03 / $562.34
| Professional | | $162.18 | $309.03 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,258.93 / $3,162.28
| Facility | | $380.19 | $1,258.93 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $371.54 / $831.76
| Professional | | $223.87 | $371.54 | $831.76 |
- 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
- $186.21 / $302.00 / $588.84
| Professional | | $186.21 | $302.00 | $588.84 |