- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,127.66 / $2,436.56 / $2,534.02
| Facility | | $2,127.66 | $2,436.56 | $2,534.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,175.42 / $2,471.89 / $2,714.24
| Professional | | $2,175.42 | $2,471.89 | $2,714.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,187.08 / $5,119.81 / $5,380.92
| Facility | | $3,187.08 | $5,119.81 | $5,380.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,394.64 / $2,732.14 / $2,779.11
| Professional | | $2,394.64 | $2,732.14 | $2,779.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,839.86 / $7,129.11 / $8,200.70
| Facility | | $3,839.86 | $7,129.11 | $8,200.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,863.82 / $6,365.28 / $8,447.69
| Professional | | $4,863.82 | $6,365.28 | $8,447.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,294.10 / $3,294.10 / $5,999.77
| Facility | | $3,294.10 | $3,294.10 | $5,999.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,404.69 / $3,294.10 / $24,422.17
| Professional | | $2,404.69 | $3,294.10 | $24,422.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,633.19 / $3,211.21 / $4,014.01
| Professional | | $2,633.19 | $3,211.21 | $4,014.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,702.81 / $2,554.21 / $3,472.86
| Professional | | $1,702.81 | $2,554.21 | $3,472.86 |