- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $3,801.89 / $10,232.93
| Facility | | $512.86 | $3,801.89 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $478.63 / $1,000.00
| Professional | | $302.00 | $478.63 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $6,025.60 / $12,302.69
| Facility | | $1,949.84 | $6,025.60 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $446.68 / $870.96
| Professional | | $295.12 | $446.68 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $933.25 / $2,691.53
| Facility | | $489.78 | $933.25 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $512.86 / $1,096.48
| Professional | | $316.23 | $512.86 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,890.45 / $9,549.93
| Facility | | $1,023.29 | $3,890.45 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $446.68 / $831.76
| Professional | | $281.84 | $446.68 | $831.76 |