- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,606.43 / $1,780.26 / $2,039.64
| Facility | | $1,606.43 | $1,780.26 | $2,039.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,540.50 / $1,901.03 / $3,395.07
| Professional | | $1,540.50 | $1,901.03 | $3,395.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,326.75 / $2,326.75 / $2,326.75
| Facility | | $2,326.75 | $2,326.75 | $2,326.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.53 / $1,698.53 / $2,441.01
| Professional | | $1,698.53 | $1,698.53 | $2,441.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,381.00 / $2,381.00 / $2,381.00
| Facility | | $2,381.00 | $2,381.00 | $2,381.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,072.53 / $2,590.66 / $3,877.26
| Professional | | $2,072.53 | $2,590.66 | $3,877.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.84 / $64.38 / $70.81
| Professional | | $41.84 | $64.38 | $70.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,514.56 / $1,893.95 / $2,465.63
| Professional | | $1,514.56 | $1,893.95 | $2,465.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.38 / $64.38 / $2,063.89
| Professional | | $64.38 | $64.38 | $2,063.89 |