- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,511.89 / $3,311.31
| Facility | | $2,187.76 | $2,511.89 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,698.24 / $2,398.83
| Professional | | $1,318.26 | $1,698.24 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.88 / $70.79 / $95.50
| Facility | | $58.88 | $70.79 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,412.54 / $1,905.46
| Professional | | $1,230.27 | $1,412.54 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,778.28 / $4,786.30
| Facility | | $1,445.44 | $1,778.28 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,995.26 / $2,187.76
| Facility | | $933.25 | $1,995.26 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $933.25 / $1,318.26
| Professional | | $933.25 | $933.25 | $1,318.26 |