- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,678.11 / $1,729.03 / $2,058.48
| Facility | | $1,678.11 | $1,729.03 | $2,058.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.23 / $1,745.25 / $2,296.37
| Professional | | $1,380.23 | $1,745.25 | $2,296.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,108.93 / $3,522.14 / $6,914.96
| Facility | | $3,108.93 | $3,522.14 | $6,914.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,790.67 / $1,790.67 / $2,499.57
| Professional | | $1,790.67 | $1,790.67 | $2,499.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,253.75 / $2,253.75 / $2,253.75
| Facility | | $2,253.75 | $2,253.75 | $2,253.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,915.69 / $1,915.69 / $2,321.36
| Professional | | $1,915.69 | $1,915.69 | $2,321.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,227.07 / $1,649.54 / $2,488.28
| Professional | | $1,227.07 | $1,649.54 | $2,488.28 |