- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,513.56 / $9,772.37
| Facility | | $1,122.02 | $1,513.56 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $660.69 / $1,380.38
| Professional | | $426.58 | $660.69 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $1,737.80
| Facility | | $1,737.80 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $602.56 / $1,047.13
| Professional | | $426.58 | $602.56 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $3,801.89 / $11,481.54
| Facility | | $1,202.26 | $3,801.89 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $602.56 / $977.24
| Professional | | $446.68 | $602.56 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,479.11
| Facility | | $1,000.00 | $1,000.00 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $602.56 / $954.99
| Professional | | $426.58 | $602.56 | $954.99 |