- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.55 / $2,014.80 / $2,044.17
| Facility | | $1,965.55 | $2,014.80 | $2,044.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,789.31 / $2,098.44 / $2,350.26
| Professional | | $1,789.31 | $2,098.44 | $2,350.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.98 / $4,130.10 / $4,340.75
| Facility | | $2,570.98 | $4,130.10 | $4,340.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,014.80 / $2,480.56 / $2,542.58
| Professional | | $2,014.80 | $2,480.56 | $2,542.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,097.58 / $5,823.46 / $7,182.96
| Facility | | $3,097.58 | $5,823.46 | $7,182.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,923.60 / $5,162.64 / $6,814.68
| Professional | | $3,923.60 | $5,162.64 | $6,814.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,148.57 / $3,148.57 / $5,049.42
| Facility | | $3,148.57 | $3,148.57 | $5,049.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,298.46 / $3,148.57 / $21,163.66
| Professional | | $2,298.46 | $3,148.57 | $21,163.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,124.17 / $2,590.46 / $3,238.07
| Professional | | $2,124.17 | $2,590.46 | $3,238.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,373.64 / $2,060.46 / $3,153.07
| Professional | | $1,373.64 | $2,060.46 | $3,153.07 |