- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,517.20 / $1,517.20 / $2,185.69
| Facility | | $1,517.20 | $1,517.20 | $2,185.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.46 / $1,639.27 / $1,639.27
| Professional | | $588.46 | $1,639.27 | $1,639.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $819.63 / $890.66 / $3,278.52
| Facility | | $819.63 | $890.66 | $3,278.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $798.32 / $966.01 / $1,207.51
| Professional | | $798.32 | $966.01 | $1,207.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $790.21 / $1,639.27 / $1,737.63
| Facility | | $790.21 | $1,639.27 | $1,737.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $840.65 / $840.65 / $1,008.78
| Professional | | $840.65 | $840.65 | $1,008.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,260.98 / $1,681.30 / $3,026.34
| Facility | | $1,260.98 | $1,681.30 | $3,026.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $714.55 / $1,256.19 / $1,298.56
| Professional | | $714.55 | $1,256.19 | $1,298.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.07 / $353.07 / $1,008.78
| Professional | | $353.07 | $353.07 | $1,008.78 |