- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,515.62 / $1,984.34 / $2,063.71
| Facility | | $1,515.62 | $1,984.34 | $2,063.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,771.67 / $2,212.07 / $2,477.52
| Professional | | $1,771.67 | $2,212.07 | $2,477.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,595.56 / $4,169.58 / $4,382.22
| Facility | | $2,595.56 | $4,169.58 | $4,382.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,950.20 / $2,504.26 / $2,547.31
| Professional | | $1,950.20 | $2,504.26 | $2,547.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,127.19 / $5,879.11 / $7,514.83
| Facility | | $3,127.19 | $5,879.11 | $7,514.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,961.10 / $5,345.33 / $6,879.81
| Professional | | $3,961.10 | $5,345.33 | $6,879.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,006.81 / $3,006.81 / $5,442.10
| Facility | | $3,006.81 | $3,006.81 | $5,442.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,194.96 / $3,006.81 / $22,809.49
| Professional | | $2,194.96 | $3,006.81 | $22,809.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,179.03 / $2,657.36 / $3,321.70
| Professional | | $2,179.03 | $2,657.36 | $3,321.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,386.78 / $2,093.75 / $3,188.99
| Professional | | $1,386.78 | $2,093.75 | $3,188.99 |