- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,005.49 / $2,055.73 / $2,085.69
| Facility | | $2,005.49 | $2,055.73 | $2,085.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,825.66 / $2,146.96 / $2,404.60
| Professional | | $1,825.66 | $2,146.96 | $2,404.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,623.23 / $4,214.02 / $4,428.93
| Facility | | $2,623.23 | $4,214.02 | $4,428.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,055.73 / $2,530.96 / $2,578.42
| Professional | | $2,055.73 | $2,530.96 | $2,578.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,160.52 / $5,941.77 / $7,345.44
| Facility | | $3,160.52 | $5,941.77 | $7,345.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,003.32 / $5,267.53 / $6,953.13
| Professional | | $4,003.32 | $5,267.53 | $6,953.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,741.63 / $2,741.63 / $5,167.63
| Facility | | $2,741.63 | $2,741.63 | $5,167.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,001.39 / $2,741.63 / $21,659.10
| Professional | | $2,001.39 | $2,741.63 | $21,659.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,167.33 / $2,643.09 / $3,303.86
| Professional | | $2,167.33 | $2,643.09 | $3,303.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,401.55 / $2,230.57 / $3,167.57
| Professional | | $1,401.55 | $2,230.57 | $3,167.57 |