- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,440.69 / $2,624.28 / $4,481.13
| Facility | | $2,440.69 | $2,624.28 | $4,481.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,429.89 / $2,478.48 / $2,953.25
| Professional | | $2,429.89 | $2,478.48 | $2,953.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $858.75 / $1,354.69 / $2,148.00
| Facility | | $858.75 | $1,354.69 | $2,148.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,292.35 / $2,292.35 / $2,429.89
| Facility | | $2,292.35 | $2,292.35 | $2,429.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,429.89 / $2,429.89 / $2,429.89
| Professional | | $2,429.89 | $2,429.89 | $2,429.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,917.04 / $2,635.96 / $3,690.34
| Facility | | $1,917.04 | $2,635.96 | $3,690.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,318.67 / $2,441.48 / $3,070.40
| Professional | | $2,318.67 | $2,441.48 | $3,070.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,429.89 / $2,429.89 / $2,721.48
| Professional | | $2,429.89 | $2,429.89 | $2,721.48 |