- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,905.46 / $6,760.83
| Facility | | $1,380.38 | $1,905.46 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,047.13 / $1,659.59
| Professional | | $776.25 | $1,047.13 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,570.40 / $4,073.80
| Facility | | $1,412.54 | $2,570.40 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $794.33 / $794.33
| Professional | | $537.03 | $794.33 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,023.29 / $10,000.00
| Facility | | $851.14 | $1,023.29 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,513.56 / $1,862.09
| Professional | | $1,513.56 | $1,513.56 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,174.90 / $1,318.26
| Facility | | $549.54 | $1,174.90 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $645.65 / $1,445.44
| Professional | | $524.81 | $645.65 | $1,445.44 |