- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,923.84 / $1,923.84 / $2,308.61
| Facility | | $1,923.84 | $1,923.84 | $2,308.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,453.05 / $1,504.89 / $1,923.84
| Professional | | $1,453.05 | $1,504.89 | $1,923.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,416.71 / $3,416.71 / $4,050.17
| Facility | | $3,416.71 | $3,416.71 | $4,050.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,738.10 / $1,738.10 / $1,846.73
| Professional | | $1,738.10 | $1,738.10 | $1,846.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,808.29 / $1,808.29 / $1,808.29
| Facility | | $1,808.29 | $1,808.29 | $1,808.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,537.05 / $1,537.05 / $1,808.29
| Professional | | $1,537.05 | $1,537.05 | $1,808.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,766.35 / $2,766.35 / $8,538.34
| Professional | | $2,766.35 | $2,766.35 | $8,538.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,136.36 / $1,704.56 / $2,172.62
| Professional | | $1,136.36 | $1,704.56 | $2,172.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,252.46 / $2,477.71 / $3,153.46
| Professional | | $2,252.46 | $2,477.71 | $3,153.46 |