- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $4,570.88 / $11,481.54
| Facility | | $524.81 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $380.19 / $831.76
| Professional | | $309.03 | $380.19 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,011.87 / $13,489.63
| Facility | | $2,570.40 | $5,011.87 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $457.09 / $851.14
| Professional | | $309.03 | $457.09 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,000.00 / $2,884.03
| Facility | | $323.59 | $1,000.00 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $537.03 / $1,096.48
| Professional | | $338.84 | $537.03 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $2,691.53 / $6,165.95
| Facility | | $707.95 | $2,691.53 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $426.58 / $776.25
| Professional | | $295.12 | $426.58 | $776.25 |