- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $4,570.88 / $11,481.54
| Facility | | $588.84 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $416.87 / $933.25
| Professional | | $323.59 | $416.87 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $8,511.38 / $17,782.79
| Facility | | $3,467.37 | $8,511.38 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $512.86 / $933.25
| Professional | | $338.84 | $512.86 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $1,000.00 / $2,884.03
| Facility | | $363.08 | $1,000.00 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $588.84 / $1,318.26
| Professional | | $380.19 | $588.84 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,235.94 / $10,471.29
| Facility | | $851.14 | $3,235.94 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $489.78 / $912.01
| Professional | | $346.74 | $489.78 | $912.01 |