- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,691.53 / $7,585.78
| Facility | | $2,398.83 | $2,691.53 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $1,288.25 / $4,677.35
| Professional | | $446.68 | $1,288.25 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,137.96 / $2,951.21
| Facility | | $954.99 | $2,137.96 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $512.86 / $794.33
| Facility | | $457.09 | $512.86 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $1,096.48
| Professional | | $1,096.48 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $56.23 / $2,089.30
| Facility | | $54.95 | $56.23 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,090.30 / $6,760.83
| Professional | | $3,090.30 | $3,090.30 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $2,187.76 / $3,981.07
| Facility | | $912.01 | $2,187.76 | $3,981.07 |