- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,698.24 / $2,238.72
| Facility | | $1,230.27 | $1,698.24 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $1,548.82 / $2,041.74
| Professional | | $501.19 | $1,548.82 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,000.00 / $1,202.26
| Facility | | $549.54 | $1,000.00 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $478.63 / $1,122.02
| Professional | | $436.52 | $478.63 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50,118.72 / $53,703.18 / $75,857.76
| Facility | | $50,118.72 | $53,703.18 | $75,857.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,258.93 / $1,584.89
| Facility | | $870.96 | $1,258.93 | $1,584.89 |