- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,041.74 / $6,025.60
| Facility | | $1,445.44 | $2,041.74 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,380.38 / $1,737.80
| Professional | | $1,071.52 | $1,380.38 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $4,677.35 / $6,456.54
| Facility | | $4,677.35 | $4,677.35 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,258.93 / $1,659.59
| Professional | | $1,258.93 | $1,258.93 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $4,570.88 / $4,570.88
| Facility | | $4,570.88 | $4,570.88 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,995.26 / $2,238.72
| Professional | | $912.01 | $1,995.26 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,981.07 / $10,232.93
| Facility | | $1,548.82 | $3,981.07 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,318.26 / $2,344.23
| Professional | | $1,047.13 | $1,318.26 | $2,344.23 |