- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,453.51 / $1,938.01 / $4,651.22
| Facility | | $1,453.51 | $1,938.01 | $4,651.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,434.13 / $1,434.13 / $2,073.67
| Professional | | $1,434.13 | $1,434.13 | $2,073.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,259.71 / $1,259.71 / $5,177.41
| Facility | | $1,259.71 | $1,259.71 | $5,177.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,360.51 / $2,360.51 / $2,828.16
| Professional | | $2,360.51 | $2,360.51 | $2,828.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,434.13 / $1,938.01 / $3,255.86
| Facility | | $1,434.13 | $1,938.01 | $3,255.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $813.96 / $813.96 / $2,907.02
| Professional | | $813.96 | $813.96 | $2,907.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $813.96 / $813.96 / $1,240.33
| Professional | | $813.96 | $813.96 | $1,240.33 |