- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,010.59 / $1,537.02 / $3,507.63
| Facility | | $1,010.59 | $1,537.02 | $3,507.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $814.62 / $1,010.59 / $1,075.91
| Professional | | $814.62 | $1,010.59 | $1,075.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $556.80 / $2,255.58 / $3,804.12
| Facility | | $556.80 | $2,255.58 | $3,804.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.65 / $1,016.73 / $1,660.91
| Professional | | $691.65 | $1,016.73 | $1,660.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $999.06 / $4,943.60 / $8,821.82
| Facility | | $999.06 | $4,943.60 | $8,821.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,075.91 / $2,416.96 / $3,796.44
| Professional | | $1,075.91 | $2,416.96 | $3,796.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.54 / $922.21 / $2,697.32
| Professional | | $645.54 | $922.21 | $2,697.32 |