- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,135.68 / $1,862.06 / $3,694.29
| Facility | | $1,135.68 | $1,862.06 | $3,694.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $935.26 / $1,095.58 / $1,255.92
| Professional | | $935.26 | $1,095.58 | $1,255.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $813.87 / $1,960.71 / $5,210.75
| Facility | | $813.87 | $1,960.71 | $5,210.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.14 / $516.23 / $1,336.09
| Professional | | $423.14 | $516.23 | $1,336.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,028.69 / $2,072.35 / $4,154.93
| Facility | | $1,028.69 | $2,072.35 | $4,154.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,627.23 / $1,627.84 / $1,992.59
| Professional | | $1,627.23 | $1,627.84 | $1,992.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.48 / $1,269.28 / $1,603.31
| Facility | | $1,202.48 | $1,269.28 | $1,603.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.16 / $801.65 / $1,536.50
| Professional | | $561.16 | $801.65 | $1,536.50 |