- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,852.34 / $1,861.06 / $2,421.92
| Facility | | $1,852.34 | $1,861.06 | $2,421.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,523.68 / $1,861.06 / $2,611.19
| Professional | | $1,523.68 | $1,861.06 | $2,611.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,383.69 / $3,735.30 / $6,902.73
| Facility | | $3,383.69 | $3,735.30 | $6,902.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,032.26 / $2,067.19 / $2,813.48
| Professional | | $2,032.26 | $2,067.19 | $2,813.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,375.33 / $2,375.33 / $2,375.33
| Facility | | $2,375.33 | $2,375.33 | $2,375.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,733.99 / $2,324.27 / $2,446.59
| Professional | | $1,733.99 | $2,324.27 | $2,446.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,834.85 / $4,511.59 / $4,511.59
| Facility | | $3,834.85 | $4,511.59 | $4,511.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,406.74 / $1,739.75 / $2,628.07
| Professional | | $1,406.74 | $1,739.75 | $2,628.07 |