- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,522.93 / $1,526.02 / $1,915.78
| Facility | | $1,522.93 | $1,526.02 | $1,915.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,302.19 / $1,554.02 / $2,259.12
| Professional | | $1,302.19 | $1,554.02 | $2,259.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,946.56 / $3,154.34 / $5,893.12
| Facility | | $2,946.56 | $3,154.34 | $5,893.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,619.76 / $1,647.60 / $2,431.61
| Professional | | $1,619.76 | $1,647.60 | $2,431.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,952.91 / $1,952.91 / $1,952.91
| Facility | | $1,952.91 | $1,952.91 | $1,952.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,425.62 / $1,910.94 / $2,081.90
| Professional | | $1,425.62 | $1,910.94 | $2,081.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,127.68 / $1,506.11 / $2,133.87
| Professional | | $1,127.68 | $1,506.11 | $2,133.87 |