- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,306.47 / $2,917.26 / $3,804.57
| Facility | | $1,306.47 | $2,917.26 | $3,804.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,152.77 / $1,306.47 / $1,306.47
| Professional | | $1,152.77 | $1,306.47 | $1,306.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,837.60 / $7,485.29 / $9,452.67
| Facility | | $5,837.60 | $7,485.29 | $9,452.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.79 / $514.79 / $859.40
| Professional | | $514.79 | $514.79 | $859.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,229.61 / $1,414.06 / $2,757.42
| Professional | | $1,229.61 | $1,414.06 | $2,757.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $999.06 / $3,388.03 / $7,873.95
| Facility | | $999.06 | $3,388.03 | $7,873.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,872.39 / $1,872.39 / $2,243.33
| Professional | | $1,872.39 | $1,872.39 | $2,243.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,537.02 / $1,844.42 / $2,274.79
| Professional | | $1,537.02 | $1,844.42 | $2,274.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,221.94 / $1,537.02 / $2,612.94
| Facility | | $1,221.94 | $1,537.02 | $2,612.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,106.00 / $2,689.79 / $3,688.85
| Professional | | $2,106.00 | $2,689.79 | $3,688.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,075.91 / $1,705.78 / $2,853.63
| Facility | | $1,075.91 | $1,705.78 | $2,853.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,075.91 / $1,747.59 / $2,853.63
| Professional | | $1,075.91 | $1,747.59 | $2,853.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,844.42 / $1,844.42 / $1,844.42
| Facility | | $1,844.42 | $1,844.42 | $1,844.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.54 / $799.25 / $2,092.33
| Professional | | $645.54 | $799.25 | $2,092.33 |