- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,677.35 / $8,511.38
| Facility | | $2,290.87 | $4,677.35 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $128.82 / $181.97
| Professional | | $112.20 | $128.82 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,365.16 / $10,964.78
| Facility | | $3,715.35 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $141.25 / $194.98
| Professional | | $102.33 | $141.25 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,698.24
| Facility | | $1,000.00 | $1,000.00 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $199.53 / $407.38
| Professional | | $123.03 | $199.53 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $346.74 / $524.81
| Professional | | $186.21 | $346.74 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $5,248.07 / $8,912.51
| Facility | | $912.01 | $5,248.07 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $151.36 / $346.74
| Professional | | $104.71 | $151.36 | $346.74 |