- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,042.15 / $2,198.94 / $2,793.80
| Facility | | $1,042.15 | $2,198.94 | $2,793.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $748.21 / $1,042.15 / $2,605.38
| Professional | | $748.21 | $1,042.15 | $2,605.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $434.23 / $1,336.09 / $3,206.62
| Facility | | $434.23 | $1,336.09 | $3,206.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.14 / $423.14 / $808.33
| Professional | | $423.14 | $423.14 | $808.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $868.46 / $1,563.23 / $2,171.15
| Facility | | $868.46 | $1,563.23 | $2,171.15 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $1,336.09 / $1,336.09 / $1,402.89
| Professional | | $1,336.09 | $1,336.09 | $1,402.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.16 / $561.16 / $1,402.89
| Professional | | $561.16 | $561.16 | $1,402.89 |