- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,462.01 / $3,212.52 / $9,137.59
| Facility | | $1,462.01 | $3,212.52 | $9,137.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $913.76 / $913.76 / $1,057.34
| Professional | | $913.76 | $913.76 | $1,057.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,147.33 / $2,386.21 / $5,090.93
| Facility | | $2,147.33 | $2,386.21 | $5,090.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $522.15 / $848.49 / $848.49
| Professional | | $522.15 | $848.49 | $848.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,357.11 / $4,772.57 / $5,726.46
| Facility | | $2,357.11 | $4,772.57 | $5,726.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,305.36 / $1,771.65 / $4,029.02
| Professional | | $1,305.36 | $1,771.65 | $4,029.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.26 / $783.22 / $1,305.36
| Professional | | $548.26 | $783.22 | $1,305.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,500.00 / $2,750.00 / $3,500.00
| Professional | | $2,500.00 | $2,750.00 | $3,500.00 |