- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,513.56 / $8,511.38
| Facility | | $1,445.44 | $1,513.56 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,513.56 / $2,238.72
| Professional | | $1,380.38 | $1,513.56 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,548.13 / $4,168.69
| Professional | | $2,884.03 | $3,548.13 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,818.38 / $4,897.79
| Professional | | $2,041.74 | $2,818.38 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,238.72 / $4,466.84
| Facility | | $1,513.56 | $2,238.72 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,754.23 / $3,235.94
| Professional | | $1,318.26 | $2,754.23 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,041.74 / $2,041.74
| Facility | | $1,819.70 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,754.23 / $3,630.78
| Professional | | $1,318.26 | $2,754.23 | $3,630.78 |