- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,290.87 / $5,623.41
| Facility | | $1,096.48 | $2,290.87 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,071.52 / $1,698.24
| Professional | | $724.44 | $1,071.52 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,737.80 / $6,165.95
| Facility | | $1,122.02 | $1,737.80 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $691.83 / $2,818.38
| Professional | | $537.03 | $691.83 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $2,511.89 / $5,623.41
| Facility | | $870.96 | $2,511.89 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,621.81 / $3,235.94
| Professional | | $676.08 | $1,621.81 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,348.96 / $1,621.81
| Facility | | $602.56 | $1,348.96 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $812.83 / $1,548.82
| Professional | | $562.34 | $812.83 | $1,548.82 |