- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,140.64 / $1,147.63 / $1,480.83
| Facility | | $1,140.64 | $1,147.63 | $1,480.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $961.51 / $1,178.04 / $1,710.96
| Professional | | $961.51 | $1,178.04 | $1,710.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,153.08 / $2,568.76 / $4,250.14
| Facility | | $2,153.08 | $2,568.76 | $4,250.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,222.46 / $1,243.47 / $1,977.02
| Professional | | $1,222.46 | $1,243.47 | $1,977.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,271.83 / $1,271.83 / $1,404.19
| Facility | | $1,271.83 | $1,271.83 | $1,404.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $928.44 / $1,271.83 / $1,309.98
| Professional | | $928.44 | $1,271.83 | $1,309.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $866.72 / $1,165.03 / $1,618.06
| Professional | | $866.72 | $1,165.03 | $1,618.06 |