- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,344.23 / $6,025.60
| Facility | | $1,096.48 | $2,344.23 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,071.52 / $1,548.82
| Professional | | $794.33 | $1,071.52 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,238.72 / $6,456.54
| Facility | | $1,023.29 | $2,238.72 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $512.86 / $1,819.70
| Professional | | $426.58 | $512.86 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $2,238.72 / $5,754.40
| Facility | | $870.96 | $2,238.72 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,949.84 / $3,981.07
| Professional | | $1,548.82 | $1,949.84 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,348.96 / $1,621.81
| Facility | | $794.33 | $1,348.96 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $794.33 / $1,621.81
| Professional | | $562.34 | $794.33 | $1,621.81 |