- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,436.17 / $2,116.23 / $2,200.88
| Facility | | $1,436.17 | $2,116.23 | $2,200.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,889.44 / $2,146.92 / $2,357.40
| Professional | | $1,889.44 | $2,146.92 | $2,357.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,768.09 / $4,446.72 / $4,673.51
| Facility | | $2,768.09 | $4,446.72 | $4,673.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,079.83 / $2,372.98 / $2,699.26
| Professional | | $2,079.83 | $2,372.98 | $2,699.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,335.05 / $6,191.85 / $7,122.67
| Facility | | $3,335.05 | $6,191.85 | $7,122.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,224.39 / $5,528.44 / $7,337.10
| Professional | | $4,224.39 | $5,528.44 | $7,337.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,060.59 / $3,060.59 / $5,211.01
| Facility | | $3,060.59 | $3,060.59 | $5,211.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,234.23 / $2,469.71 / $21,290.13
| Professional | | $2,234.23 | $2,469.71 | $21,290.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,323.88 / $2,834.00 / $3,542.50
| Professional | | $2,323.88 | $2,834.00 | $3,542.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,478.96 / $2,218.42 / $3,037.41
| Professional | | $1,478.96 | $2,218.42 | $3,037.41 |