- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,645.41 / $2,056.76 / $3,552.93
| Facility | | $1,645.41 | $2,056.76 | $3,552.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,645.41 / $1,645.41 / $1,645.41
| Professional | | $1,645.41 | $1,645.41 | $1,645.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $383.45 / $500.30 / $975.56
| Facility | | $383.45 | $500.30 | $975.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.07 / $1,689.33 / $1,706.40
| Professional | | $1,621.07 | $1,689.33 | $1,706.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,748.25 / $2,517.39 / $4,214.20
| Professional | | $1,748.25 | $2,517.39 | $4,214.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,040.32 / $1,834.52 / $7,712.85
| Facility | | $1,040.32 | $1,834.52 | $7,712.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,713.97 / $1,713.97 / $2,570.96
| Professional | | $1,713.97 | $1,713.97 | $2,570.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,560.48 / $2,175.15 / $3,818.11
| Facility | | $1,560.48 | $2,175.15 | $3,818.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,012.42 / $2,749.66 / $4,124.72
| Professional | | $2,012.42 | $2,749.66 | $4,124.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,628.27 / $1,713.97 / $2,056.76
| Professional | | $1,628.27 | $1,713.97 | $2,056.76 |