- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,189.46 / $1,958.05 / $3,668.09
| Facility | | $1,189.46 | $1,958.05 | $3,668.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $979.03 / $1,044.30 / $1,227.05
| Professional | | $979.03 | $1,044.30 | $1,227.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.40 / $1,915.63 / $5,090.93
| Facility | | $1,148.40 | $1,915.63 | $5,090.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $789.74 / $1,148.40 / $1,305.36
| Professional | | $789.74 | $1,148.40 | $1,305.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $932.91 / $2,024.90 / $4,005.02
| Facility | | $932.91 | $2,024.90 | $4,005.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,500.02 / $1,500.02 / $1,875.02
| Professional | | $1,500.02 | $1,500.02 | $1,875.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,240.09 / $1,240.09 / $1,566.44
| Facility | | $1,240.09 | $1,240.09 | $1,566.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.26 / $783.22 / $1,476.37
| Professional | | $548.26 | $783.22 | $1,476.37 |