- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $922.21 / $1,152.77 / $6,655.30
| Facility | | $922.21 | $1,152.77 | $6,655.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $837.68 / $1,045.17 / $1,383.32
| Professional | | $837.68 | $1,045.17 | $1,383.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $772.19 / $1,081.06 / $5,779.60
| Facility | | $772.19 | $1,081.06 | $5,779.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,872.39 / $1,872.39 / $2,243.33
| Professional | | $1,872.39 | $1,872.39 | $2,243.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $922.21 / $922.21 / $1,306.47
| Professional | | $922.21 | $922.21 | $1,306.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,537.02 / $1,537.02 / $2,305.53
| Facility | | $1,537.02 | $1,537.02 | $2,305.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.96 / $645.54 / $2,877.30
| Professional | | $537.96 | $645.54 | $2,877.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $922.21 / $922.21 / $922.21
| Professional | | $922.21 | $922.21 | $922.21 |