- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,600.12 / $1,714.90 / $2,166.61
| Facility | | $1,600.12 | $1,714.90 | $2,166.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,311.02 / $1,714.90 / $2,400.17
| Professional | | $1,311.02 | $1,714.90 | $2,400.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,870.49 / $3,619.94 / $6,613.02
| Facility | | $2,870.49 | $3,619.94 | $6,613.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,736.33 / $1,744.37 / $2,755.25
| Professional | | $1,736.33 | $1,744.37 | $2,755.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,784.15 / $1,784.15 / $1,854.74
| Facility | | $1,784.15 | $1,784.15 | $1,854.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,302.43 / $1,784.15 / $1,837.67
| Professional | | $1,302.43 | $1,784.15 | $1,837.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,208.49 / $1,691.98 / $2,374.12
| Professional | | $1,208.49 | $1,691.98 | $2,374.12 |