- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,546.47 / $1,770.06 / $2,412.48
| Facility | | $1,546.47 | $1,770.06 | $2,412.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,546.47 / $1,770.06 / $1,770.06
| Professional | | $1,546.47 | $1,770.06 | $1,770.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,306.58 / $1,306.58 / $1,306.58
| Facility | | $1,306.58 | $1,306.58 | $1,306.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,241.26 / $1,306.58 / $1,453.32
| Professional | | $1,241.26 | $1,306.58 | $1,453.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,863.04 / $1,863.04 / $2,328.80
| Professional | | $1,863.04 | $1,863.04 | $2,328.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,593.05 / $1,770.06 / $2,841.64
| Facility | | $1,593.05 | $1,770.06 | $2,841.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,770.06 / $1,788.69 / $2,235.86
| Professional | | $1,770.06 | $1,788.69 | $2,235.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $782.55 / $1,117.93 / $1,863.22
| Professional | | $782.55 | $1,117.93 | $1,863.22 |