- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,002.07 / $1,336.09 / $3,206.62
| Facility | | $1,002.07 | $1,336.09 | $3,206.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $988.71 / $988.71 / $1,429.62
| Professional | | $988.71 | $988.71 | $1,429.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $868.46 / $868.46 / $3,569.37
| Facility | | $868.46 | $868.46 | $3,569.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,627.23 / $1,627.23 / $1,949.60
| Professional | | $1,627.23 | $1,627.23 | $1,949.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.71 / $1,336.09 / $2,244.63
| Facility | | $988.71 | $1,336.09 | $2,244.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.16 / $561.16 / $5,017.33
| Professional | | $561.16 | $561.16 | $5,017.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.99 / $1,336.09 / $1,603.31
| Facility | | $480.99 | $1,336.09 | $1,603.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.16 / $561.16 / $1,336.09
| Professional | | $561.16 | $561.16 | $1,336.09 |