- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,451.61 / $1,740.66 / $2,149.09
| Facility | | $1,451.61 | $1,740.66 | $2,149.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $715.15 / $1,010.31 / $2,511.90
| Professional | | $715.15 | $1,010.31 | $2,511.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.00 / $842.00 / $842.00
| Facility | | $842.00 | $842.00 | $842.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,064.06 / $1,672.94 / $2,395.37
| Professional | | $1,064.06 | $1,672.94 | $2,395.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,414.01 / $1,805.16 / $2,138.65
| Professional | | $1,414.01 | $1,805.16 | $2,138.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,010.31 / $1,563.84 / $2,279.75
| Facility | | $1,010.31 | $1,563.84 | $2,279.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,222.69 / $1,546.28 / $2,210.36
| Professional | | $1,222.69 | $1,546.28 | $2,210.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,137.78 / $1,668.31 / $1,921.56
| Facility | | $1,137.78 | $1,668.31 | $1,921.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,010.31 / $1,563.84 / $2,279.75
| Facility | | $1,010.31 | $1,563.84 | $2,279.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,325.44 / $1,702.27 / $2,309.88
| Professional | | $1,325.44 | $1,702.27 | $2,309.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,539.74 / $4,494.80 / $5,709.03
| Facility | | $3,539.74 | $4,494.80 | $5,709.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,343.36 / $1,767.00 / $2,433.17
| Professional | | $1,343.36 | $1,767.00 | $2,433.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,689.00 / $5,130.00 / $7,385.00
| Facility | | $1,689.00 | $5,130.00 | $7,385.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,242.72 / $1,832.68 / $2,675.99
| Professional | | $1,242.72 | $1,832.68 | $2,675.99 |