- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,007.42 / $1,349.64 / $2,104.33
| Facility | | $1,007.42 | $1,349.64 | $2,104.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $983.72 / $1,007.42 / $1,198.94
| Professional | | $983.72 | $1,007.42 | $1,198.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.72 / $1,248.17 / $2,967.52
| Facility | | $456.72 | $1,248.17 | $2,967.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,046.93 / $1,046.93 / $1,151.61
| Professional | | $1,046.93 | $1,046.93 | $1,151.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,046.93 / $1,046.93 / $1,046.93
| Facility | | $1,046.93 | $1,046.93 | $1,046.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,046.93 / $1,046.93 / $1,046.93
| Professional | | $1,046.93 | $1,046.93 | $1,046.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.19 / $593.19 / $593.19
| Facility | | $593.19 | $593.19 | $593.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,185.20 / $1,185.20 / $1,220.76
| Professional | | $1,185.20 | $1,185.20 | $1,220.76 |