- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,630.78 / $6,456.54
| Facility | | $1,698.24 | $3,630.78 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,318.26 / $1,659.59
| Professional | | $776.25 | $1,318.26 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $2,187.76
| Professional | | $2,187.76 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,162.28 / $3,981.07
| Facility | | $1,584.89 | $3,162.28 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,737.80 / $2,344.23
| Facility | | $1,380.38 | $1,737.80 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $676.08 / $8,709.64
| Professional | | $467.74 | $676.08 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,737.80 / $2,089.30
| Facility | | $676.08 | $1,737.80 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $676.08 / $1,445.44
| Professional | | $467.74 | $676.08 | $1,445.44 |