- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,268.59 / $1,876.47 / $1,936.56
| Facility | | $1,268.59 | $1,876.47 | $1,936.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,268.59 / $1,637.19 / $2,642.92
| Professional | | $1,268.59 | $1,637.19 | $2,642.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,776.72 / $2,915.56 / $12,817.34
| Facility | | $2,776.72 | $2,915.56 | $12,817.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,544.24 / $1,722.19 / $2,247.32
| Professional | | $1,544.24 | $1,722.19 | $2,247.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,084.13 / $2,084.13 / $2,084.13
| Facility | | $2,084.13 | $2,084.13 | $2,084.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,521.41 / $1,521.41 / $2,221.79
| Professional | | $1,521.41 | $1,521.41 | $2,221.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,289.24 / $2,237.80 / $14,469.30
| Facility | | $1,289.24 | $2,237.80 | $14,469.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,145.16 / $1,541.76 / $2,922.14
| Professional | | $1,145.16 | $1,541.76 | $2,922.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,815.91 / $2,070.03 / $2,221.38
| Facility | | $1,815.91 | $2,070.03 | $2,221.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,075.98 / $1,395.80 / $2,117.59
| Professional | | $1,075.98 | $1,395.80 | $2,117.59 |