- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,008.67 / $1,574.27 / $3,787.11
| Facility | | $1,008.67 | $1,574.27 | $3,787.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $878.05 / $1,479.69 / $2,114.75
| Professional | | $878.05 | $1,479.69 | $2,114.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $874.10 / $1,436.62 / $2,981.98
| Facility | | $874.10 | $1,436.62 | $2,981.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $788.82 / $1,298.35 / $1,788.92
| Professional | | $788.82 | $1,298.35 | $1,788.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $434.50 / $713.09 / $1,235.82
| Facility | | $434.50 | $713.09 | $1,235.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,243.96 / $2,243.96 / $2,243.96
| Professional | | $2,243.96 | $2,243.96 | $2,243.96 |