- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,353.78 / $1,359.13 / $1,838.49
| Facility | | $1,353.78 | $1,359.13 | $1,838.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,113.57 / $1,434.62 / $2,038.69
| Professional | | $1,113.57 | $1,434.62 | $2,038.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,531.31 / $3,008.74 / $5,491.16
| Facility | | $2,531.31 | $3,008.74 | $5,491.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,456.62 / $1,481.65 / $2,332.41
| Professional | | $1,456.62 | $1,481.65 | $2,332.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,769.38 / $1,769.38 / $1,769.38
| Facility | | $1,769.38 | $1,769.38 | $1,769.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,291.65 / $1,769.38 / $1,822.46
| Professional | | $1,291.65 | $1,769.38 | $1,822.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,008.28 / $1,410.61 / $1,918.95
| Professional | | $1,008.28 | $1,410.61 | $1,918.95 |