- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,684.44 / $1,728.23 / $2,150.19
| Facility | | $1,684.44 | $1,728.23 | $2,150.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,324.81 / $1,732.93 / $2,425.41
| Professional | | $1,324.81 | $1,732.93 | $2,425.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,960.40 / $3,835.48 / $6,441.74
| Facility | | $2,960.40 | $3,835.48 | $6,441.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,748.40 / $1,748.40 / $2,708.91
| Professional | | $1,748.40 | $1,748.40 | $2,708.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,289.62 / $2,289.62 / $2,289.62
| Facility | | $2,289.62 | $2,289.62 | $2,289.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,671.42 / $1,671.42 / $3,869.13
| Professional | | $1,671.42 | $1,671.42 | $3,869.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,283.70 / $1,660.57 / $2,460.29
| Professional | | $1,283.70 | $1,660.57 | $2,460.29 |