- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,848.92 / $1,861.84 / $2,234.21
| Facility | | $1,848.92 | $1,861.84 | $2,234.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,478.15 / $1,933.84 / $2,853.30
| Professional | | $1,478.15 | $1,933.84 | $2,853.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,282.57 / $3,810.20 / $6,793.28
| Facility | | $3,282.57 | $3,810.20 | $6,793.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,946.42 / $1,947.88 / $3,072.54
| Professional | | $1,946.42 | $1,947.88 | $3,072.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,561.34 / $2,561.34 / $2,561.34
| Facility | | $2,561.34 | $2,561.34 | $2,561.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,869.78 / $2,459.17 / $2,730.51
| Professional | | $1,869.78 | $2,459.17 | $2,730.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,339.96 / $1,840.66 / $2,550.19
| Professional | | $1,339.96 | $1,840.66 | $2,550.19 |