- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $1,780.21 / $2,726.70
| Facility | | $1,400.00 | $1,780.21 | $2,726.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,770.87 / $1,866.47 / $3,026.38
| Professional | | $1,770.87 | $1,866.47 | $3,026.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,759.69 / $1,902.07 / $2,300.66
| Facility | | $1,759.69 | $1,902.07 | $2,300.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,049.08 / $2,045.03 / $2,045.03
| Professional | | $1,049.08 | $2,045.03 | $2,045.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,047.39 / $2,047.39 / $2,047.39
| Facility | | $2,047.39 | $2,047.39 | $2,047.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,742.71 / $2,628.15 / $5,837.97
| Professional | | $1,742.71 | $2,628.15 | $5,837.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,453.02 / $2,255.46 / $3,211.05
| Professional | | $1,453.02 | $2,255.46 | $3,211.05 |