- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,344.23 / $3,981.07
| Facility | | $1,949.84 | $2,344.23 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,344.23 / $3,801.89
| Professional | | $1,949.84 | $2,344.23 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,511.89 / $9,120.11
| Facility | | $1,862.09 | $2,511.89 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,754.23 / $5,623.41
| Professional | | $2,290.87 | $2,754.23 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $2,951.21 / $18,620.87
| Facility | | $2,951.21 | $2,951.21 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $6,606.93
| Professional | | $2,137.96 | $2,137.96 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $3,090.30 / $5,495.41
| Facility | | $1,995.26 | $3,090.30 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,290.87 / $3,467.37
| Professional | | $1,698.24 | $2,290.87 | $3,467.37 |