- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,189.46 / $1,924.12 / $5,208.43
| Facility | | $1,189.46 | $1,924.12 | $5,208.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $868.07 / $1,083.46 / $1,109.56
| Professional | | $868.07 | $1,083.46 | $1,109.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $482.28 / $1,831.57 / $2,901.47
| Facility | | $482.28 | $1,831.57 | $2,901.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $459.17 / $667.89 / $3,235.08
| Professional | | $459.17 | $667.89 | $3,235.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $871.97 / $2,121.23 / $3,818.21
| Facility | | $871.97 | $2,121.23 | $3,818.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $874.60 / $1,305.36 / $2,403.01
| Facility | | $874.60 | $1,305.36 | $2,403.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.26 / $548.26 / $6,500.74
| Professional | | $548.26 | $548.26 | $6,500.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.26 / $548.26 / $783.22
| Professional | | $548.26 | $548.26 | $783.22 |