- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $4,073.80 / $7,762.47
| Facility | | $524.81 | $4,073.80 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $457.09 / $1,096.48
| Professional | | $389.05 | $457.09 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $1,778.28 / $4,073.80
| Professional | | $398.11 | $1,778.28 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $467.74 / $1,148.15
| Professional | | $371.54 | $467.74 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $831.76 / $933.25
| Professional | | $380.19 | $831.76 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $10,000.00 / $26,302.68
| Facility | | $2,344.23 | $10,000.00 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $416.87 / $1,122.02
| Professional | | $302.00 | $416.87 | $1,122.02 |