- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,597.78 / $1,597.78 / $1,917.34
| Facility | | $1,597.78 | $1,597.78 | $1,917.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,121.24 / $1,239.83 / $1,597.78
| Professional | | $1,121.24 | $1,239.83 | $1,597.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,837.63 / $2,837.63 / $3,363.73
| Facility | | $2,837.63 | $2,837.63 | $3,363.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,526.81 / $1,526.81 / $1,602.21
| Professional | | $1,526.81 | $1,526.81 | $1,602.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,119.51 / $2,119.51 / $2,119.51
| Facility | | $2,119.51 | $2,119.51 | $2,119.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,547.24 / $1,547.24 / $2,119.51
| Professional | | $1,547.24 | $1,547.24 | $2,119.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,297.51 / $2,297.51 / $7,091.26
| Professional | | $2,297.51 | $2,297.51 | $7,091.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $943.78 / $1,415.66 / $2,297.51
| Professional | | $943.78 | $1,415.66 | $2,297.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,125.29 / $2,337.82 / $2,975.41
| Professional | | $2,125.29 | $2,337.82 | $2,975.41 |