- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,043.16 / $2,197.36 / $2,517.51
| Facility | | $2,043.16 | $2,197.36 | $2,517.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,972.42 / $2,197.36 / $3,561.90
| Professional | | $1,972.42 | $2,197.36 | $3,561.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,794.61 / $3,421.60 / $3,589.22
| Professional | | $1,794.61 | $3,421.60 | $3,589.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,481.10 / $2,481.10 / $2,481.10
| Facility | | $2,481.10 | $2,481.10 | $2,481.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,811.20 / $1,811.20 / $2,729.98
| Professional | | $1,811.20 | $1,811.20 | $2,729.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,790.67 / $2,933.52 / $2,933.52
| Facility | | $1,790.67 | $2,933.52 | $2,933.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,558.10 / $3,197.63 / $4,785.63
| Professional | | $2,558.10 | $3,197.63 | $4,785.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,764.73 / $2,714.98 / $2,986.47
| Professional | | $1,764.73 | $2,714.98 | $2,986.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,571.57 / $2,600.65 / $2,965.23
| Facility | | $1,571.57 | $2,600.65 | $2,965.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,968.04 / $2,387.50 / $2,965.23
| Professional | | $1,968.04 | $2,387.50 | $2,965.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,714.98 / $2,714.98 / $2,714.98
| Professional | | $2,714.98 | $2,714.98 | $2,714.98 |