- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $3,388.44 / $9,549.93
| Facility | | $588.84 | $3,388.44 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $457.09 / $812.83
| Professional | | $234.42 | $457.09 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,365.16 / $9,549.93
| Facility | | $1,584.89 | $4,365.16 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $501.19 / $977.24
| Professional | | $295.12 | $501.19 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $954.99 / $11,481.54
| Facility | | $263.03 | $954.99 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $537.03 / $1,000.00
| Professional | | $239.88 | $537.03 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $1,071.52 / $3,388.44
| Facility | | $229.09 | $1,071.52 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $537.03 / $954.99
| Professional | | $363.08 | $537.03 | $954.99 |