- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,513.56 / $2,570.40
| Facility | | $1,412.54 | $1,513.56 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,548.82 / $2,454.71
| Professional | | $1,318.26 | $1,548.82 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,949.84
| Facility | | $1,621.81 | $1,621.81 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $1,737.80
| Professional | | $1,737.80 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,570.40 / $2,570.40
| Facility | | $2,511.89 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,187.76 / $8,317.64
| Professional | | $1,412.54 | $2,187.76 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $9,120.11
| Facility | | $1,230.27 | $1,230.27 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,513.56 / $2,290.87
| Professional | | $1,096.48 | $1,513.56 | $2,290.87 |