- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,379.41 / $2,040.38 / $2,105.71
| Facility | | $1,379.41 | $2,040.38 | $2,105.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,379.41 / $1,625.88 / $2,873.77
| Professional | | $1,379.41 | $1,625.88 | $2,873.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.25 / $3,170.21 / $13,936.86
| Facility | | $3,019.25 | $3,170.21 | $13,936.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,667.58 / $1,693.61 / $2,442.69
| Professional | | $1,667.58 | $1,693.61 | $2,442.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,125.02 / $2,125.02 / $2,125.02
| Facility | | $2,125.02 | $2,125.02 | $2,125.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,551.26 / $1,551.26 / $2,188.77
| Professional | | $1,551.26 | $1,551.26 | $2,188.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,379.41 / $2,433.27 / $14,520.96
| Facility | | $1,379.41 | $2,433.27 | $14,520.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,157.85 / $1,631.79 / $2,901.95
| Professional | | $1,157.85 | $1,631.79 | $2,901.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,149.51 / $1,506.27 / $2,141.06
| Professional | | $1,149.51 | $1,506.27 | $2,141.06 |