- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.46 / $1,994.60 / $2,058.48
| Facility | | $1,348.46 | $1,994.60 | $2,058.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.46 / $1,947.78 / $2,809.30
| Professional | | $1,348.46 | $1,947.78 | $2,809.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.51 / $3,099.09 / $13,624.17
| Facility | | $2,951.51 | $3,099.09 | $13,624.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,443.06 / $1,790.67 / $2,389.02
| Professional | | $1,443.06 | $1,790.67 | $2,389.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,253.75 / $2,253.75 / $2,253.75
| Facility | | $2,253.75 | $2,253.75 | $2,253.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,915.69 / $1,915.69 / $2,321.36
| Professional | | $1,915.69 | $1,915.69 | $2,321.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,372.32 / $2,378.69 / $15,333.41
| Facility | | $1,372.32 | $2,378.69 | $15,333.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,227.07 / $1,638.83 / $3,148.28
| Professional | | $1,227.07 | $1,638.83 | $3,148.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,152.94 / $1,539.23 / $2,269.04
| Professional | | $1,152.94 | $1,539.23 | $2,269.04 |