- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,119.47 / $1,547.26 / $2,041.53
| Professional | | $1,119.47 | $1,547.26 | $2,041.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,408.48 / $1,408.48 / $1,539.31
| Facility | | $1,408.48 | $1,408.48 | $1,539.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,028.19 / $1,408.48 / $1,450.73
| Professional | | $1,028.19 | $1,408.48 | $1,450.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $592.83 / $1,381.88 / $1,840.64
| Facility | | $592.83 | $1,381.88 | $1,840.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,656.58 / $1,748.61 / $1,840.64
| Professional | | $1,656.58 | $1,748.61 | $1,840.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $1,358.39 / $1,617.75
| Professional | | $30.00 | $1,358.39 | $1,617.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,611.73 / $1,797.50 / $2,696.25
| Facility | | $1,611.73 | $1,797.50 | $2,696.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.45 / $1,343.67 / $1,932.67
| Professional | | $1,288.45 | $1,343.67 | $1,932.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $849.02 / $918.28 / $2,304.98
| Professional | | $849.02 | $918.28 | $2,304.98 |