- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,262.41 / $2,273.67 / $2,931.65
| Facility | | $2,262.41 | $2,273.67 | $2,931.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,847.52 / $2,286.48 / $3,433.62
| Professional | | $1,847.52 | $2,286.48 | $3,433.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,221.70 / $4,999.62 / $8,360.75
| Facility | | $4,221.70 | $4,999.62 | $8,360.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,469.21 / $2,469.21 / $3,670.78
| Professional | | $2,469.21 | $2,469.21 | $3,670.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,550.04 / $2,550.04 / $2,554.66
| Facility | | $2,550.04 | $2,550.04 | $2,554.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,861.53 / $2,550.04 / $2,990.32
| Professional | | $1,861.53 | $2,550.04 | $2,990.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,625.10 / $5,441.30 / $5,441.30
| Facility | | $4,625.10 | $5,441.30 | $5,441.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,696.63 / $2,164.59 / $3,229.01
| Professional | | $1,696.63 | $2,164.59 | $3,229.01 |