- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,276.33 / $1,314.84 / $1,589.45
| Facility | | $1,276.33 | $1,314.84 | $1,589.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,094.38 / $1,326.80 / $1,914.49
| Professional | | $1,094.38 | $1,326.80 | $1,914.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,353.42 / $2,638.46 / $4,646.10
| Facility | | $2,353.42 | $2,638.46 | $4,646.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,372.14 / $1,376.42 / $2,123.58
| Professional | | $1,372.14 | $1,376.42 | $2,123.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,654.54 / $1,654.54 / $1,654.54
| Facility | | $1,654.54 | $1,654.54 | $1,654.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,207.81 / $1,566.65 / $1,763.81
| Professional | | $1,207.81 | $1,566.65 | $1,763.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,009.97 / $1,256.21 / $1,893.70
| Professional | | $1,009.97 | $1,256.21 | $1,893.70 |