- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,441.25 / $2,089.35 / $2,172.92
| Facility | | $1,441.25 | $2,089.35 | $2,172.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,865.43 / $2,106.14 / $2,339.01
| Professional | | $1,865.43 | $2,106.14 | $2,339.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,732.93 / $4,390.25 / $4,614.14
| Facility | | $2,732.93 | $4,390.25 | $4,614.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,053.41 / $2,381.38 / $2,396.26
| Professional | | $2,053.41 | $2,381.38 | $2,396.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,292.69 / $5,926.84 / $7,021.20
| Facility | | $3,292.69 | $5,926.84 | $7,021.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,170.74 / $5,485.31 / $7,243.91
| Professional | | $4,170.74 | $5,485.31 | $7,243.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,728.17 / $2,728.17 / $5,144.82
| Facility | | $2,728.17 | $2,728.17 | $5,144.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,991.56 / $2,728.17 / $21,424.95
| Professional | | $1,991.56 | $2,728.17 | $21,424.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,294.35 / $2,797.99 / $3,497.48
| Professional | | $2,294.35 | $2,797.99 | $3,497.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,460.16 / $2,190.25 / $3,048.16
| Professional | | $1,460.16 | $2,190.25 | $3,048.16 |