- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $3,715.35 / $9,772.37
| Facility | | $870.96 | $3,715.35 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $501.19 / $1,202.26
| Professional | | $398.11 | $501.19 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $5,754.40 / $12,882.50
| Facility | | $2,630.27 | $5,754.40 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $645.65 / $1,174.90
| Professional | | $446.68 | $645.65 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,412.54 / $4,073.80
| Facility | | $323.59 | $1,412.54 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $741.31 / $1,548.82
| Professional | | $478.63 | $741.31 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,691.53 / $6,309.57
| Facility | | $1,000.00 | $2,691.53 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $616.60 / $1,122.02
| Professional | | $436.52 | $616.60 | $1,122.02 |