- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,632.17 / $1,689.94 / $1,993.73
| Facility | | $1,632.17 | $1,689.94 | $1,993.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,383.32 / $1,689.94 / $2,448.26
| Professional | | $1,383.32 | $1,689.94 | $2,448.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.48 / $3,553.89 / $6,404.13
| Facility | | $2,912.48 | $3,553.89 | $6,404.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,754.72 / $1,760.19 / $2,529.36
| Professional | | $1,754.72 | $1,760.19 | $2,529.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.89 / $1,819.89 / $1,831.30
| Facility | | $1,819.89 | $1,819.89 | $1,831.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,328.52 / $1,819.89 / $1,940.10
| Professional | | $1,328.52 | $1,819.89 | $1,940.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,776.27 / $1,776.27 / $1,776.27
| Facility | | $1,776.27 | $1,776.27 | $1,776.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,210.83 / $1,579.50 / $2,304.46
| Professional | | $1,210.83 | $1,579.50 | $2,304.46 |