- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,448.56 / $2,815.84 / $4,897.12
| Facility | | $2,448.56 | $2,815.84 | $4,897.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,909.88 / $2,693.42 / $2,815.84
| Professional | | $1,909.88 | $2,693.42 | $2,815.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.89 / $652.76 / $878.17
| Facility | | $537.89 | $652.76 | $878.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.21 / $448.43 / $1,644.74
| Professional | | $369.21 | $448.43 | $1,644.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,559.73 / $1,989.45 / $5,299.89
| Facility | | $1,559.73 | $1,989.45 | $5,299.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,014.76 / $1,089.58 / $2,577.89
| Professional | | $1,014.76 | $1,089.58 | $2,577.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,203.69 / $2,203.69 / $2,448.56
| Facility | | $2,203.69 | $2,203.69 | $2,448.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,028.40 / $1,028.40 / $1,469.14
| Professional | | $1,028.40 | $1,028.40 | $1,469.14 |