- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.20 / $1,852.55 / $1,926.65
| Facility | | $1,346.20 | $1,852.55 | $1,926.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,654.01 / $1,953.22 / $2,247.16
| Professional | | $1,654.01 | $1,953.22 | $2,247.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.17 / $3,892.65 / $4,091.18
| Facility | | $2,423.17 | $3,892.65 | $4,091.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,820.68 / $2,224.32 / $2,262.55
| Professional | | $1,820.68 | $2,224.32 | $2,262.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,919.49 / $5,370.03 / $6,745.49
| Facility | | $2,919.49 | $5,370.03 | $6,745.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,698.02 / $4,865.81 / $6,422.87
| Professional | | $3,698.02 | $4,865.81 | $6,422.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,970.85 / $2,970.85 / $4,704.04
| Facility | | $2,970.85 | $2,970.85 | $4,704.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,168.71 / $2,970.85 / $19,716.07
| Professional | | $2,168.71 | $2,970.85 | $19,716.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,034.32 / $2,480.88 / $3,101.10
| Professional | | $2,034.32 | $2,480.88 | $3,101.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,294.67 / $1,942.01 / $3,079.37
| Professional | | $1,294.67 | $1,942.01 | $3,079.37 |