- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.48 / $1,741.23 / $2,270.09
| Facility | | $1,698.48 | $1,741.23 | $2,270.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,389.96 / $1,824.37 / $2,611.84
| Professional | | $1,389.96 | $1,824.37 | $2,611.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,107.08 / $3,917.63 / $6,976.88
| Facility | | $3,107.08 | $3,917.63 | $6,976.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,889.45 / $1,898.20 / $2,879.96
| Professional | | $1,889.45 | $1,898.20 | $2,879.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,479.82 / $2,479.82 / $2,479.82
| Facility | | $2,479.82 | $2,479.82 | $2,479.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,810.27 / $2,426.54 / $2,554.21
| Professional | | $1,810.27 | $2,426.54 | $2,554.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,349.45 / $1,775.90 / $2,583.48
| Professional | | $1,349.45 | $1,775.90 | $2,583.48 |