- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,187.76 / $5,754.40
| Facility | | $1,071.52 | $2,187.76 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,023.29 / $1,288.25
| Professional | | $831.76 | $1,023.29 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,398.83 / $6,165.95
| Facility | | $1,258.93 | $2,398.83 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,445.44 / $2,511.89
| Professional | | $1,148.15 | $1,445.44 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,137.96 / $4,897.79
| Facility | | $831.76 | $2,137.96 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,862.09 / $3,467.37
| Professional | | $1,479.11 | $1,862.09 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,258.93 / $1,513.56
| Facility | | $758.58 | $1,258.93 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $758.58 / $1,513.56
| Professional | | $537.03 | $758.58 | $1,513.56 |