- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,168.52 / $1,168.52 / $1,251.72
| Facility | | $1,168.52 | $1,168.52 | $1,251.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,168.52 / $1,168.52 / $1,168.52
| Professional | | $1,168.52 | $1,168.52 | $1,168.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.43 / $296.51 / $573.54
| Facility | | $225.43 | $296.51 | $573.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,556.57 / $2,799.30 / $2,903.59
| Professional | | $2,556.57 | $2,799.30 | $2,903.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,215.69 / $4,019.62 / $4,532.43
| Professional | | $3,215.69 | $4,019.62 | $4,532.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $637.37 / $1,168.52 / $8,409.78
| Facility | | $637.37 | $1,168.52 | $8,409.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,062.29 / $1,062.29 / $5,116.68
| Professional | | $1,062.29 | $1,062.29 | $5,116.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,124.58 / $3,647.19 / $4,532.43
| Facility | | $2,124.58 | $3,647.19 | $4,532.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,124.58 / $3,647.19 / $4,869.60
| Professional | | $2,124.58 | $3,647.19 | $4,869.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,071.46 / $2,071.46 / $3,611.78
| Professional | | $2,071.46 | $2,071.46 | $3,611.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,062.29 / $1,947.53 / $7,081.92
| Facility | | $1,062.29 | $1,947.53 | $7,081.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,009.17 / $1,062.29 / $3,452.44
| Professional | | $1,009.17 | $1,062.29 | $3,452.44 |