- 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
- $979.03 / $979.03 / $5,208.43
| Professional | | $979.03 | $979.03 | $5,208.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $730.23 / $2,872.55 / $4,777.54
| Facility | | $730.23 | $2,872.55 | $4,777.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $756.08 / $1,099.75 / $1,567.15
| Professional | | $756.08 | $1,099.75 | $1,567.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $863.34 / $2,121.23 / $3,818.21
| Facility | | $863.34 | $2,121.23 | $3,818.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,500.02 / $1,590.88 / $1,988.60
| Professional | | $1,500.02 | $1,590.88 | $1,988.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $783.22 / $1,057.34 / $6,200.51
| Facility | | $783.22 | $1,057.34 | $6,200.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.26 / $548.26 / $1,044.30
| Professional | | $548.26 | $548.26 | $1,044.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.26 / $548.26 / $839.35
| Professional | | $548.26 | $548.26 | $839.35 |