- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,663.66 / $2,226.79 / $2,315.86
| Facility | | $1,663.66 | $2,226.79 | $2,315.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,988.14 / $2,413.82 / $2,910.54
| Professional | | $1,988.14 | $2,413.82 | $2,910.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.70 / $4,679.03 / $4,917.66
| Facility | | $2,912.70 | $4,679.03 | $4,917.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,188.58 / $2,748.86 / $2,796.11
| Professional | | $2,188.58 | $2,748.86 | $2,796.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,509.27 / $6,597.43 / $8,736.79
| Facility | | $3,509.27 | $6,597.43 | $8,736.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,641.43 / $6,279.58 / $7,720.40
| Professional | | $4,641.43 | $6,279.58 | $7,720.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,532.34 / $3,532.34 / $5,902.32
| Facility | | $3,532.34 | $3,532.34 | $5,902.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,578.61 / $3,532.34 / $24,738.41
| Professional | | $2,578.61 | $3,532.34 | $24,738.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,445.28 / $2,982.06 / $3,727.57
| Professional | | $2,445.28 | $2,982.06 | $3,727.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,050.06 / $3,050.06 / $3,050.06
| Facility | | $3,050.06 | $3,050.06 | $3,050.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,556.22 / $2,334.32 / $3,494.10
| Professional | | $1,556.22 | $2,334.32 | $3,494.10 |