- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.28 / $1,646.34 / $2,302.86
| Facility | | $912.28 | $1,646.34 | $2,302.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $558.54 / $736.25 / $820.88
| Professional | | $558.54 | $736.25 | $820.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,016.36 / $1,536.69 / $1,920.86
| Professional | | $1,016.36 | $1,536.69 | $1,920.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $930.90 / $1,480.97 / $1,620.49
| Professional | | $930.90 | $1,480.97 | $1,620.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $844.25 / $1,016.36 / $2,259.54
| Facility | | $844.25 | $1,016.36 | $2,259.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.76 / $846.27 / $3,329.29
| Professional | | $507.76 | $846.27 | $3,329.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,015.52 / $1,551.72 / $2,458.36
| Facility | | $1,015.52 | $1,551.72 | $2,458.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,015.52 / $1,551.72 / $2,157.98
| Professional | | $1,015.52 | $1,551.72 | $2,157.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $846.27 / $846.27 / $1,510.59
| Professional | | $846.27 | $846.27 | $1,510.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.76 / $507.76 / $1,732.74
| Professional | | $507.76 | $507.76 | $1,732.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $846.27 / $846.27 / $846.27
| Professional | | $846.27 | $846.27 | $846.27 |