- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,344.23 / $6,025.60
| Facility | | $1,122.02 | $2,344.23 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,071.52 / $1,548.82
| Professional | | $870.96 | $1,071.52 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,089.30 / $6,606.93
| Facility | | $1,202.26 | $2,089.30 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $794.33 / $2,041.74
| Professional | | $691.83 | $794.33 | $2,041.74 |
- 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 / $3,630.78
| Professional | | $1,548.82 | $1,949.84 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,348.96 / $1,621.81
| Facility | | $562.34 | $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 |