- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,048.80 / $1,373.14 / $1,428.06
| Facility | | $1,048.80 | $1,373.14 | $1,428.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,225.97 / $1,517.82 / $1,886.57
| Professional | | $1,225.97 | $1,517.82 | $1,886.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,796.10 / $2,885.30 / $3,032.45
| Facility | | $1,796.10 | $2,885.30 | $3,032.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,418.62 / $1,732.93 / $1,773.27
| Professional | | $1,418.62 | $1,732.93 | $1,773.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,163.98 / $4,068.27 / $5,482.07
| Facility | | $2,163.98 | $4,068.27 | $5,482.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,885.30 / $3,895.16 / $4,955.18
| Professional | | $2,885.30 | $3,895.16 | $4,955.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,289.62 / $2,289.62 / $3,837.70
| Facility | | $2,289.62 | $2,289.62 | $3,837.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,671.42 / $2,206.77 / $16,084.97
| Professional | | $1,671.42 | $2,206.77 | $16,084.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,507.87 / $1,838.87 / $2,298.58
| Professional | | $1,507.87 | $1,838.87 | $2,298.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $983.62 / $1,439.45 / $2,282.94
| Professional | | $983.62 | $1,439.45 | $2,282.94 |