- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,324.74 / $1,339.67 / $1,663.07
| Facility | | $1,324.74 | $1,339.67 | $1,663.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,158.58 / $1,349.06 / $2,019.81
| Professional | | $1,158.58 | $1,349.06 | $2,019.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,330.48 / $1,330.48 / $3,305.62
| Facility | | $1,330.48 | $1,330.48 | $3,305.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,330.48 / $1,425.38 / $2,713.74
| Professional | | $1,330.48 | $1,425.38 | $2,713.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,482.94 / $1,482.94 / $1,482.94
| Facility | | $1,482.94 | $1,482.94 | $1,482.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,260.50 / $1,477.89 / $1,527.43
| Professional | | $1,260.50 | $1,477.89 | $1,527.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $991.61 / $1,339.93 / $1,885.37
| Professional | | $991.61 | $1,339.93 | $1,885.37 |