- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $975.51 / $1,937.09 / $5,051.62
| Facility | | $975.51 | $1,937.09 | $5,051.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $841.94 / $1,050.83 / $1,076.16
| Professional | | $841.94 | $1,050.83 | $1,076.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $770.22 / $2,925.06 / $4,633.71
| Facility | | $770.22 | $2,925.06 | $4,633.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $733.32 / $1,066.64 / $5,166.54
| Professional | | $733.32 | $1,066.64 | $5,166.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $735.37 / $1,975.08 / $3,538.69
| Facility | | $735.37 | $1,975.08 | $3,538.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $848.27 / $1,266.07 / $2,410.09
| Facility | | $848.27 | $1,266.07 | $2,410.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.75 / $531.75 / $6,305.03
| Professional | | $531.75 | $531.75 | $6,305.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.75 / $531.75 / $759.64
| Professional | | $531.75 | $531.75 | $759.64 |