- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,527.34 / $1,527.34 / $2,200.30
| Facility | | $1,527.34 | $1,527.34 | $2,200.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.39 / $1,650.23 / $1,650.23
| Professional | | $592.39 | $1,650.23 | $1,650.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.10 / $1,760.26 / $3,300.48
| Facility | | $660.10 | $1,760.26 | $3,300.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,018.23 / $1,650.23 / $1,815.25
| Facility | | $1,018.23 | $1,650.23 | $1,815.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $846.27 / $846.27 / $1,015.52
| Professional | | $846.27 | $846.27 | $1,015.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $1,650.23
| Professional | | $30.00 | $30.00 | $1,650.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,269.41 / $1,692.54 / $3,046.57
| Facility | | $1,269.41 | $1,692.54 | $3,046.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,264.65 / $1,264.65 / $1,306.93
| Professional | | $1,264.65 | $1,264.65 | $1,306.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.43 / $355.43 / $973.21
| Professional | | $355.43 | $355.43 | $973.21 |