- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,466.18 / $1,780.50 / $2,209.16
| Facility | | $1,466.18 | $1,780.50 | $2,209.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,590.13 / $1,935.46 / $3,341.52
| Professional | | $1,590.13 | $1,935.46 | $3,341.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,247.00 / $9,663.00
| Facility | | $2,088.00 | $4,247.00 | $9,663.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,057.38 / $2,521.30 / $4,018.94
| Professional | | $2,057.38 | $2,521.30 | $4,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,983.56 / $2,863.75 / $4,535.58
| Professional | | $1,983.56 | $2,863.75 | $4,535.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,684.76 / $2,851.15 / $5,504.00
| Facility | | $1,684.76 | $2,851.15 | $5,504.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,310.82 / $3,488.79 / $15,904.32
| Professional | | $2,310.82 | $3,488.79 | $15,904.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,156.00 / $4,000.00 / $10,781.00
| Facility | | $2,156.00 | $4,000.00 | $10,781.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,833.46 / $2,690.98 / $4,283.82
| Professional | | $1,833.46 | $2,690.98 | $4,283.82 |