- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,398.24 / $2,068.23 / $2,134.48
| Facility | | $1,398.24 | $2,068.23 | $2,134.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,398.24 / $1,602.16 / $2,913.01
| Professional | | $1,398.24 | $1,602.16 | $2,913.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,060.48 / $3,213.50 / $14,127.18
| Facility | | $3,060.48 | $3,213.50 | $14,127.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,471.56 / $1,484.70 / $2,476.06
| Professional | | $1,471.56 | $1,484.70 | $2,476.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.17 / $1,787.17 / $1,787.17
| Facility | | $1,787.17 | $1,787.17 | $1,787.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,304.63 / $1,304.63 / $1,304.63
| Professional | | $1,304.63 | $1,304.63 | $1,304.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,366.01 / $2,466.51 / $13,048.73
| Facility | | $1,366.01 | $2,466.51 | $13,048.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,018.62 / $1,615.26 / $2,613.48
| Professional | | $1,018.62 | $1,615.26 | $2,613.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,448.21 / $1,448.21 / $1,448.21
| Facility | | $1,448.21 | $1,448.21 | $1,448.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,018.62 / $1,538.44 / $2,184.76
| Professional | | $1,018.62 | $1,538.44 | $2,184.76 |