- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $944.53 / $1,397.12 / $1,441.87
| Facility | | $944.53 | $1,397.12 | $1,441.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $944.53 / $1,082.27 / $1,967.77
| Professional | | $944.53 | $1,082.27 | $1,967.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,067.38 / $2,170.75 / $9,543.03
| Facility | | $2,067.38 | $2,170.75 | $9,543.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $957.82 / $957.82 / $1,672.60
| Professional | | $957.82 | $957.82 | $1,672.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.64 / $1,020.64 / $1,020.64
| Facility | | $1,020.64 | $1,020.64 | $1,020.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $745.07 / $745.07 / $1,051.26
| Professional | | $745.07 | $745.07 | $1,051.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $889.11 / $1,657.67 / $8,461.77
| Facility | | $889.11 | $1,657.67 | $8,461.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $687.60 / $1,051.33 / $1,701.07
| Professional | | $687.60 | $1,051.33 | $1,701.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $687.60 / $1,031.40 / $1,381.39
| Professional | | $687.60 | $1,031.40 | $1,381.39 |