- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,311.31 / $11,748.98
| Facility | | $2,398.83 | $3,311.31 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,819.70 / $2,754.23
| Professional | | $1,380.38 | $1,819.70 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $4,466.84 / $7,079.46
| Facility | | $2,454.71 | $4,466.84 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,288.25 / $1,288.25
| Professional | | $1,096.48 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $2,290.87
| Facility | | $2,290.87 | $2,290.87 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,570.40 / $17,378.01
| Facility | | $1,479.11 | $2,570.40 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,290.87 / $2,290.87
| Facility | | $954.99 | $2,290.87 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,148.15 / $3,162.28
| Professional | | $954.99 | $1,148.15 | $3,162.28 |