- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,489.74 / $1,498.12 / $1,920.83
| Facility | | $1,489.74 | $1,498.12 | $1,920.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,242.08 / $1,522.21 / $2,302.15
| Professional | | $1,242.08 | $1,522.21 | $2,302.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,738.66 / $3,310.90 / $5,478.04
| Facility | | $2,738.66 | $3,310.90 | $5,478.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,644.85 / $1,660.84 / $2,515.30
| Professional | | $1,644.85 | $1,660.84 | $2,515.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,711.28 / $1,711.28 / $1,711.28
| Facility | | $1,711.28 | $1,711.28 | $1,711.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,249.23 / $1,711.28 / $1,911.42
| Professional | | $1,249.23 | $1,711.28 | $1,911.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,176.07 / $1,501.61 / $2,277.15
| Professional | | $1,176.07 | $1,501.61 | $2,277.15 |