- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,311.31 / $6,606.93
| Facility | | $1,698.24 | $3,311.31 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,445.44 / $1,778.28
| Professional | | $1,174.90 | $1,445.44 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,238.72
| Professional | | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,235.94 / $3,548.13
| Facility | | $1,584.89 | $3,235.94 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,778.28 / $2,398.83
| Facility | | $1,412.54 | $1,778.28 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,071.52 / $8,912.51
| Professional | | $741.31 | $1,071.52 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,778.28 / $2,137.96
| Facility | | $741.31 | $1,778.28 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,071.52 / $2,290.87
| Professional | | $741.31 | $1,071.52 | $2,290.87 |