- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,598.42 / $2,770.77 / $4,322.39
| Facility | | $2,598.42 | $2,770.77 | $4,322.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,493.69 / $3,463.46 / $4,848.85
| Professional | | $2,493.69 | $3,463.46 | $4,848.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,943.01 / $1,943.01 / $2,045.27
| Facility | | $1,943.01 | $1,943.01 | $2,045.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,943.01 / $2,045.27 / $2,274.94
| Professional | | $1,943.01 | $2,045.27 | $2,274.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,554.69 / $4,443.35 / $6,562.35
| Professional | | $3,554.69 | $4,443.35 | $6,562.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,770.77 / $2,770.77 / $5,091.29
| Facility | | $2,770.77 | $2,770.77 | $5,091.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,799.94 / $2,799.94 / $3,499.92
| Professional | | $2,799.94 | $2,799.94 | $3,499.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,224.97 / $1,749.96 / $2,916.60
| Professional | | $1,224.97 | $1,749.96 | $2,916.60 |