- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,949.84 / $3,388.44
| Facility | | $1,621.81 | $1,949.84 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,949.84 / $3,235.94
| Professional | | $1,621.81 | $1,949.84 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,089.30 / $7,585.78
| Facility | | $1,548.82 | $2,089.30 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,089.30 / $4,570.88
| Professional | | $1,995.26 | $2,089.30 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $15,135.61
| Facility | | $2,454.71 | $2,454.71 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $1,778.28 / $5,495.41
| Professional | | $1,778.28 | $1,778.28 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,630.27 / $4,677.35
| Facility | | $1,698.24 | $2,630.27 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,905.46 / $2,884.03
| Professional | | $1,412.54 | $1,905.46 | $2,884.03 |