- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,331.48 / $1,664.35 / $9,608.83
| Facility | | $1,331.48 | $1,664.35 | $9,608.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,331.48 / $1,442.43 / $1,597.77
| Professional | | $1,331.48 | $1,442.43 | $1,597.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,114.51 / $1,587.61 / $8,344.48
| Facility | | $1,114.51 | $1,587.61 | $8,344.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,549.86 / $2,704.74 / $3,380.93
| Professional | | $2,549.86 | $2,704.74 | $3,380.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,242.71 / $1,331.48 / $2,629.45
| Professional | | $1,242.71 | $1,331.48 | $2,629.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,328.70 / $3,328.70 / $3,328.70
| Facility | | $3,328.70 | $3,328.70 | $3,328.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.70 / $932.03 / $2,888.29
| Professional | | $776.70 | $932.03 | $2,888.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,149.51 / $1,331.48 / $1,331.48
| Professional | | $1,149.51 | $1,331.48 | $1,331.48 |