- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,216.58 / $1,219.01 / $1,530.39
| Facility | | $1,216.58 | $1,219.01 | $1,530.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,040.25 / $1,219.01 / $1,804.69
| Professional | | $1,040.25 | $1,219.01 | $1,804.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,353.86 / $2,519.79 / $4,707.72
| Facility | | $2,353.86 | $2,519.79 | $4,707.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,300.51 / $1,448.96 / $1,948.81
| Professional | | $1,300.51 | $1,448.96 | $1,948.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.19 / $1,346.19 / $1,346.19
| Facility | | $1,346.19 | $1,346.19 | $1,346.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $982.72 / $1,346.19 / $1,458.11
| Professional | | $982.72 | $1,346.19 | $1,458.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $895.67 / $1,203.14 / $1,704.63
| Professional | | $895.67 | $1,203.14 | $1,704.63 |