- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,129.41 / $1,478.69 / $1,537.83
| Facility | | $1,129.41 | $1,478.69 | $1,537.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,320.21 / $1,634.49 / $2,043.29
| Professional | | $1,320.21 | $1,634.49 | $2,043.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,934.16 / $3,107.08 / $3,265.54
| Facility | | $1,934.16 | $3,107.08 | $3,265.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,536.46 / $1,866.13 / $1,920.58
| Professional | | $1,536.46 | $1,866.13 | $1,920.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,330.31 / $4,380.97 / $5,903.45
| Facility | | $2,330.31 | $4,380.97 | $5,903.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,107.08 / $4,194.56 / $5,366.83
| Professional | | $3,107.08 | $4,194.56 | $5,366.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,479.82 / $2,479.82 / $4,040.95
| Facility | | $2,479.82 | $2,479.82 | $4,040.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,810.27 / $2,479.82 / $16,936.84
| Professional | | $1,810.27 | $2,479.82 | $16,936.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,623.77 / $1,980.21 / $2,475.26
| Professional | | $1,623.77 | $1,980.21 | $2,475.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,033.39 / $1,728.52 / $2,388.64
| Professional | | $1,033.39 | $1,728.52 | $2,388.64 |