- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.65 / $2,914.81 / $5,440.99
| Facility | | $1,770.65 | $2,914.81 | $5,440.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,360.25 / $1,554.57 / $1,651.73
| Professional | | $1,360.25 | $1,554.57 | $1,651.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,242.10 / $2,851.66 / $7,578.52
| Facility | | $1,242.10 | $2,851.66 | $7,578.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,273.55 / $2,720.49 / $3,439.48
| Facility | | $2,273.55 | $2,720.49 | $3,439.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.60 / $1,404.94 / $5,479.85
| Facility | | $92.60 | $1,404.94 | $5,479.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,040.58 / $1,148.40 / $1,943.21
| Professional | | $1,040.58 | $1,148.40 | $1,943.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,165.93 / $1,165.93 / $1,651.73
| Professional | | $1,165.93 | $1,165.93 | $1,651.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $884.16 / $1,263.08 / $3,158.36
| Professional | | $884.16 | $1,263.08 | $3,158.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,496.13 / $3,014.28 / $6,043.09
| Facility | | $1,496.13 | $3,014.28 | $6,043.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,366.64 / $2,366.64 / $2,835.50
| Professional | | $2,366.64 | $2,366.64 | $2,835.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,943.21 / $1,943.21 / $2,914.82
| Facility | | $1,943.21 | $1,943.21 | $2,914.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $816.15 / $1,165.93 / $2,429.01
| Professional | | $816.15 | $1,165.93 | $2,429.01 |