- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.98 / $2,105.34 / $7,732.03
| Facility | | $725.98 | $2,105.34 | $7,732.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.04 / $814.70 / $933.17
| Professional | | $691.04 | $814.70 | $933.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,203.22 / $2,651.84 / $3,083.29
| Facility | | $1,203.22 | $2,651.84 | $3,083.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $617.01 / $1,127.31 / $1,902.94
| Professional | | $617.01 | $1,127.31 | $1,902.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,165.44 / $1,396.94 / $1,396.94
| Professional | | $1,165.44 | $1,396.94 | $1,396.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,041.03 / $1,289.99 / $2,797.36
| Facility | | $1,041.03 | $1,289.99 | $2,797.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $748.77 / $1,012.53 / $1,522.64
| Professional | | $748.77 | $1,012.53 | $1,522.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.49 / $1,850.61 / $2,231.44
| Facility | | $1,023.49 | $1,850.61 | $2,231.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $689.57 / $1,055.49 / $1,706.03
| Professional | | $689.57 | $1,055.49 | $1,706.03 |