- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,425.15 / $1,900.20 / $4,560.47
| Facility | | $1,425.15 | $1,900.20 | $4,560.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,406.15 / $1,406.15 / $2,033.22
| Professional | | $1,406.15 | $1,406.15 | $2,033.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,235.13 / $1,235.13 / $1,667.43
| Facility | | $1,235.13 | $1,235.13 | $1,667.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,314.54 / $2,314.54 / $2,773.08
| Professional | | $2,314.54 | $2,314.54 | $2,773.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,406.15 / $1,496.41 / $3,135.33
| Facility | | $1,406.15 | $1,496.41 | $3,135.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $798.08 / $798.08 / $2,375.25
| Professional | | $798.08 | $798.08 | $2,375.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $798.08 / $798.08 / $1,216.13
| Professional | | $798.08 | $798.08 | $1,216.13 |