- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,067.15 / $2,284.40 / $3,720.30
| Facility | | $1,067.15 | $2,284.40 | $3,720.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $711.43 / $711.43 / $1,109.56
| Professional | | $711.43 | $711.43 | $1,109.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $789.74 / $1,148.40 / $2,410.48
| Professional | | $789.74 | $1,148.40 | $2,410.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $848.49 / $2,349.91 / $4,559.27
| Facility | | $848.49 | $2,349.91 | $4,559.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,500.02 / $1,875.02 / $6,291.88
| Professional | | $1,500.02 | $1,875.02 | $6,291.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $1,696.98 / $2,937.08
| Facility | | $319.00 | $1,696.98 | $2,937.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $522.15 / $770.17 / $2,441.04
| Professional | | $522.15 | $770.17 | $2,441.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $817.55 / $1,240.09 / $1,489.35
| Professional | | $817.55 | $1,240.09 | $1,489.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.94 / $2,349.91 / $4,699.82
| Facility | | $593.94 | $2,349.91 | $4,699.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $848.49 / $1,305.36 / $2,689.06
| Professional | | $848.49 | $1,305.36 | $2,689.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.26 / $783.22 / $1,917.24
| Professional | | $548.26 | $783.22 | $1,917.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,305.36 / $1,501.14 / $1,501.14
| Facility | | $1,305.36 | $1,501.14 | $1,501.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $817.55 / $1,305.36 / $1,568.95
| Professional | | $817.55 | $1,305.36 | $1,568.95 |