- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $4,897.79 / $8,317.64
| Facility | | $1,071.52 | $4,897.79 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $6,760.83 / $7,413.10
| Facility | | $5,888.44 | $6,760.83 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $891.25 / $1,122.02
| Professional | | $758.58 | $891.25 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,047.13 / $1,071.52
| Professional | | $977.24 | $1,047.13 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,000.00 / $1,584.89
| Facility | | $741.31 | $1,000.00 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,023.29 / $10,000.00
| Facility | | $676.08 | $1,023.29 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $9,549.93 / $19,054.61
| Facility | | $5,623.41 | $9,549.93 | $19,054.61 |