- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,895.50 / $2,486.57 / $2,586.03
| Facility | | $1,895.50 | $2,486.57 | $2,586.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,220.08 / $2,748.59 / $3,086.06
| Professional | | $2,220.08 | $2,748.59 | $3,086.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,252.50 / $5,224.89 / $5,491.37
| Facility | | $3,252.50 | $5,224.89 | $5,491.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,443.81 / $3,132.00 / $3,171.15
| Professional | | $2,443.81 | $3,132.00 | $3,171.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,918.68 / $7,367.11 / $9,263.70
| Facility | | $3,918.68 | $7,367.11 | $9,263.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,963.66 / $6,658.28 / $8,621.09
| Professional | | $4,963.66 | $6,658.28 | $8,621.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,745.37 / $3,745.37 / $6,748.33
| Facility | | $3,745.37 | $3,745.37 | $6,748.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,734.12 / $3,664.88 / $28,284.29
| Professional | | $2,734.12 | $3,664.88 | $28,284.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,730.56 / $3,329.96 / $4,162.45
| Professional | | $2,730.56 | $3,329.96 | $4,162.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.76 / $2,610.65 / $4,008.86
| Professional | | $1,737.76 | $2,610.65 | $4,008.86 |