- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,424.52 / $2,099.09 / $2,183.05
| Facility | | $1,424.52 | $2,099.09 | $2,183.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,874.12 / $2,129.51 / $2,338.28
| Professional | | $1,874.12 | $2,129.51 | $2,338.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,745.66 / $4,410.70 / $4,635.64
| Facility | | $2,745.66 | $4,410.70 | $4,635.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,062.98 / $2,353.73 / $2,635.75
| Professional | | $2,062.98 | $2,353.73 | $2,635.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.03 / $6,141.63 / $7,064.90
| Facility | | $3,308.03 | $6,141.63 | $7,064.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,190.17 / $5,483.60 / $7,277.66
| Professional | | $4,190.17 | $5,483.60 | $7,277.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,448.80 / $2,448.80 / $5,168.78
| Facility | | $2,448.80 | $2,448.80 | $5,168.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,787.62 / $2,448.80 / $21,117.48
| Professional | | $1,787.62 | $2,448.80 | $21,117.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,305.04 / $2,811.03 / $3,513.78
| Professional | | $2,305.04 | $2,811.03 | $3,513.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,466.97 / $2,200.44 / $3,012.78
| Professional | | $1,466.97 | $2,200.44 | $3,012.78 |