- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $2,068.19 / $3,200.58
| Facility | | $1,400.00 | $2,068.19 | $3,200.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,016.03 / $2,142.83 / $3,136.34
| Professional | | $2,016.03 | $2,142.83 | $3,136.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,204.17 / $2,478.61 / $2,700.49
| Facility | | $2,204.17 | $2,478.61 | $2,700.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,231.51 / $2,400.42 / $2,400.42
| Professional | | $1,231.51 | $2,400.42 | $2,400.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,355.71 / $2,355.71 / $2,355.71
| Facility | | $2,355.71 | $2,355.71 | $2,355.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,003.93 / $3,171.56 / $6,129.97
| Professional | | $2,003.93 | $3,171.56 | $6,129.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,706.31 / $2,594.78 / $3,691.40
| Professional | | $1,706.31 | $2,594.78 | $3,691.40 |