- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $4,365.16 / $10,964.78
| Facility | | $1,023.29 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $724.44 / $1,584.89
| Professional | | $602.56 | $724.44 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $7,079.46 / $14,454.40
| Facility | | $2,754.23 | $7,079.46 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $870.96 / $1,698.24
| Professional | | $588.84 | $870.96 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,862.09 / $5,011.87
| Facility | | $851.14 | $1,862.09 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,000.00 / $2,187.76
| Professional | | $660.69 | $1,000.00 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,265.80 / $10,000.00
| Facility | | $1,513.56 | $4,265.80 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $794.33 / $1,513.56
| Professional | | $562.34 | $794.33 | $1,513.56 |