- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $4,365.16 / $10,964.78
| Facility | | $1,071.52 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $891.25 / $1,949.84
| Professional | | $691.83 | $891.25 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $6,025.60 / $12,302.69
| Facility | | $2,089.30 | $6,025.60 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $977.24 / $1,862.09
| Professional | | $645.65 | $977.24 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,187.76 / $5,754.40
| Facility | | $1,174.90 | $2,187.76 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,148.15 / $2,454.71
| Professional | | $691.83 | $1,148.15 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,265.80 / $10,000.00
| Facility | | $1,584.89 | $4,265.80 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $933.25 / $1,737.80
| Professional | | $645.65 | $933.25 | $1,737.80 |