- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,160.24 / $1,160.24 / $1,392.29
| Facility | | $1,160.24 | $1,160.24 | $1,392.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $900.32 / $915.98 / $1,230.68
| Professional | | $900.32 | $915.98 | $1,230.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,060.56 / $2,060.56 / $2,442.59
| Facility | | $2,060.56 | $2,060.56 | $2,442.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,253.11 / $1,253.11 / $1,308.94
| Professional | | $1,253.11 | $1,253.11 | $1,308.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,637.27 / $1,637.27 / $1,637.27
| Facility | | $1,637.27 | $1,637.27 | $1,637.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,195.21 / $1,195.21 / $1,637.27
| Professional | | $1,195.21 | $1,195.21 | $1,637.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,668.35 / $1,668.35 / $5,149.35
| Professional | | $1,668.35 | $1,668.35 | $5,149.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,366.91 / $1,366.91 / $1,366.91
| Facility | | $1,366.91 | $1,366.91 | $1,366.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $685.33 / $1,028.00 / $1,576.86
| Professional | | $685.33 | $1,028.00 | $1,576.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,543.30 / $1,697.63 / $2,160.62
| Professional | | $1,543.30 | $1,697.63 | $2,160.62 |