- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,323.94 / $1,837.52 / $1,911.02
| Facility | | $1,323.94 | $1,837.52 | $1,911.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,640.59 / $1,939.44 / $2,588.52
| Professional | | $1,640.59 | $1,939.44 | $2,588.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,403.52 / $3,861.08 / $4,058.00
| Facility | | $2,403.52 | $3,861.08 | $4,058.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,883.55 / $2,187.55 / $2,433.05
| Professional | | $1,883.55 | $2,187.55 | $2,433.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,895.81 / $5,332.16 / $7,336.05
| Facility | | $2,895.81 | $5,332.16 | $7,336.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,861.08 / $5,212.46 / $6,798.89
| Professional | | $3,861.08 | $5,212.46 | $6,798.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,141.52 / $3,141.52 / $4,659.83
| Facility | | $3,141.52 | $3,141.52 | $4,659.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,293.31 / $3,141.52 / $19,530.78
| Professional | | $2,293.31 | $3,141.52 | $19,530.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,017.79 / $2,460.73 / $3,075.91
| Professional | | $2,017.79 | $2,460.73 | $3,075.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,284.17 / $2,064.30 / $2,800.07
| Professional | | $1,284.17 | $2,064.30 | $2,800.07 |