- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,570.40 / $2,754.23
| Facility | | $2,511.89 | $2,570.40 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $676.08 / $1,905.46
| Professional | | $537.03 | $676.08 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,630.78 / $3,630.78
| Facility | | $2,884.03 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $891.25 / $1,047.13
| Professional | | $602.56 | $891.25 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,174.90 / $1,548.82
| Professional | | $776.25 | $1,174.90 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $954.99 / $1,819.70
| Professional | | $794.33 | $954.99 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,570.40 / $2,754.23
| Facility | | $2,511.89 | $2,570.40 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $707.95 / $1,949.84
| Professional | | $575.44 | $707.95 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $891.25 / $1,621.81
| Professional | | $630.96 | $891.25 | $1,621.81 |