- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,715.35 / $9,549.93
| Facility | | $1,047.13 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $870.96 / $1,949.84
| Professional | | $676.08 | $870.96 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,248.07 / $11,220.18
| Facility | | $2,089.30 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $912.01 / $1,905.46
| Professional | | $588.84 | $912.01 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,659.59 / $5,888.44
| Facility | | $831.76 | $1,659.59 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,096.48 / $2,570.40
| Professional | | $676.08 | $1,096.48 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,884.03 / $6,456.54
| Facility | | $1,000.00 | $2,884.03 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $870.96 / $1,778.28
| Professional | | $575.44 | $870.96 | $1,778.28 |