- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,436.62 / $2,697.42 / $4,168.05
| Facility | | $1,436.62 | $2,697.42 | $4,168.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $979.03 / $1,135.67 / $1,305.36
| Professional | | $979.03 | $1,135.67 | $1,305.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,631.71 / $1,631.71 / $1,631.71
| Professional | | $1,631.71 | $1,631.71 | $1,631.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,153.95 / $2,138.19 / $2,959.85
| Facility | | $1,153.95 | $2,138.19 | $2,959.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,500.02 / $1,515.02 / $1,905.02
| Professional | | $1,500.02 | $1,515.02 | $1,905.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $783.22 / $1,070.40 / $2,388.83
| Facility | | $783.22 | $1,070.40 | $2,388.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.26 / $783.22 / $2,219.13
| Professional | | $548.26 | $783.22 | $2,219.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.26 / $783.22 / $2,219.13
| Professional | | $548.26 | $783.22 | $2,219.13 |