- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,345.81 / $2,345.81 / $2,814.97
| Facility | | $2,345.81 | $2,345.81 | $2,814.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,771.11 / $1,820.29 / $2,805.88
| Professional | | $1,771.11 | $1,820.29 | $2,805.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,166.12 / $4,166.12 / $4,938.52
| Facility | | $4,166.12 | $4,166.12 | $4,938.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,207.84 / $2,207.84 / $2,331.25
| Professional | | $2,207.84 | $2,207.84 | $2,331.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,282.71 / $2,282.71 / $2,282.71
| Facility | | $2,282.71 | $2,282.71 | $2,282.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,666.39 / $1,666.39 / $2,282.71
| Professional | | $1,666.39 | $1,666.39 | $2,282.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,373.12 / $3,373.12 / $10,411.12
| Professional | | $3,373.12 | $3,373.12 | $10,411.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,982.23 / $1,982.23 / $1,982.23
| Facility | | $1,982.23 | $1,982.23 | $1,982.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,385.62 / $2,078.42 / $3,319.45
| Professional | | $1,385.62 | $2,078.42 | $3,319.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,120.28 / $3,432.31 / $4,368.39
| Professional | | $3,120.28 | $3,432.31 | $4,368.39 |