- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $2,087.77 / $3,220.46
| Facility | | $1,400.00 | $2,087.77 | $3,220.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,038.80 / $2,182.71 / $2,959.12
| Professional | | $2,038.80 | $2,182.71 | $2,959.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,078.35 / $2,230.61 / $2,717.27
| Facility | | $2,078.35 | $2,230.61 | $2,717.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,239.27 / $2,415.35 / $2,415.35
| Professional | | $1,239.27 | $2,415.35 | $2,415.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,382.40 / $2,382.40 / $2,382.40
| Facility | | $2,382.40 | $2,382.40 | $2,382.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,028.65 / $2,983.25 / $5,540.44
| Professional | | $2,028.65 | $2,983.25 | $5,540.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,598.01 / $2,470.71 / $3,321.10
| Professional | | $1,598.01 | $2,470.71 | $3,321.10 |