- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,238.72 / $5,888.44
| Facility | | $1,071.52 | $2,238.72 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,023.29 / $1,513.56
| Professional | | $851.14 | $1,023.29 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,290.87 / $6,309.57
| Facility | | $1,318.26 | $2,290.87 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,148.15 / $1,995.26
| Professional | | $794.33 | $1,148.15 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $2,187.76 / $5,495.41
| Facility | | $851.14 | $2,187.76 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,905.46 / $3,162.28
| Professional | | $1,513.56 | $1,905.46 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,318.26 / $1,548.82
| Facility | | $588.84 | $1,318.26 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $776.25 / $1,513.56
| Professional | | $549.54 | $776.25 | $1,513.56 |