- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,071.76 / $2,362.21 / $3,003.54
| Facility | | $2,071.76 | $2,362.21 | $3,003.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $700.95 / $880.18 / $1,474.62
| Professional | | $700.95 | $880.18 | $1,474.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.04 / $904.08 / $985.01
| Facility | | $832.04 | $904.08 | $985.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $834.58 / $875.57 / $1,062.88
| Professional | | $834.58 | $875.57 | $1,062.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,334.17 / $1,334.17 / $1,334.17
| Facility | | $1,334.17 | $1,334.17 | $1,334.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $706.51 / $1,021.49 / $3,755.89
| Professional | | $706.51 | $1,021.49 | $3,755.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,890.92 / $1,890.92 / $1,890.92
| Facility | | $1,890.92 | $1,890.92 | $1,890.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,865.86 / $1,865.86 / $1,887.84
| Professional | | $1,865.86 | $1,865.86 | $1,887.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.27 / $924.40 / $1,384.83
| Professional | | $630.27 | $924.40 | $1,384.83 |