- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,187.76 / $4,897.79
| Facility | | $1,380.38 | $2,187.76 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,698.24 / $3,388.44
| Professional | | $1,288.25 | $1,698.24 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $5,754.40 / $12,589.25
| Facility | | $2,344.23 | $5,754.40 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,995.26 / $3,890.45
| Professional | | $1,412.54 | $1,995.26 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $2,754.23 / $12,302.69
| Facility | | $741.31 | $2,754.23 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,344.23 / $4,677.35
| Professional | | $1,513.56 | $2,344.23 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $6,918.31 / $15,488.17
| Facility | | $2,398.83 | $6,918.31 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,949.84 / $3,467.37
| Professional | | $1,288.25 | $1,949.84 | $3,467.37 |