- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,883.54 / $1,883.54 / $2,260.25
| Facility | | $1,883.54 | $1,883.54 | $2,260.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,461.58 / $1,493.85 / $2,252.94
| Professional | | $1,461.58 | $1,493.85 | $2,252.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,345.13 / $3,345.13 / $3,965.32
| Facility | | $3,345.13 | $3,345.13 | $3,965.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,838.86 / $1,838.86 / $1,953.79
| Professional | | $1,838.86 | $1,838.86 | $1,953.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,217.07 / $2,217.07 / $2,217.07
| Facility | | $2,217.07 | $2,217.07 | $2,217.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,618.46 / $1,618.46 / $2,363.51
| Professional | | $1,618.46 | $1,618.46 | $2,363.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,708.41 / $2,708.41 / $8,359.51
| Professional | | $2,708.41 | $2,708.41 | $8,359.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.50 / $2,094.11 / $2,291.16
| Facility | | $941.50 | $2,094.11 | $2,291.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,112.57 / $1,668.85 / $2,298.57
| Professional | | $1,112.57 | $1,668.85 | $2,298.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,505.39 / $2,755.93 / $3,507.55
| Professional | | $2,505.39 | $2,755.93 | $3,507.55 |