- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,348.96 / $2,398.83
| Facility | | $1,148.15 | $1,348.96 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,348.96 / $2,290.87
| Professional | | $1,148.15 | $1,348.96 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,380.38 / $3,467.37
| Facility | | $1,071.52 | $1,380.38 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,698.24 / $3,715.35
| Professional | | $1,071.52 | $1,698.24 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,479.11 / $10,964.78
| Facility | | $1,479.11 | $1,479.11 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,258.93 / $3,890.45
| Professional | | $1,258.93 | $1,258.93 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,659.59 / $1,819.70
| Facility | | $912.01 | $1,659.59 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,318.26 / $2,041.74
| Professional | | $977.24 | $1,318.26 | $2,041.74 |