- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,862.09 / $7,943.28
| Facility | | $1,148.15 | $1,862.09 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,122.02 / $2,290.87
| Professional | | $776.25 | $1,122.02 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,737.80 / $2,398.83
| Professional | | $1,071.52 | $1,737.80 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,584.89 / $1,905.46
| Professional | | $707.95 | $1,584.89 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,548.82 / $2,454.71
| Facility | | $1,047.13 | $1,548.82 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,659.59 / $2,290.87
| Professional | | $1,258.93 | $1,659.59 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,445.44 / $1,862.09
| Facility | | $1,258.93 | $1,445.44 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,445.44 / $2,290.87
| Facility | | $870.96 | $1,445.44 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $1,479.11 / $2,137.96
| Professional | | $79.43 | $1,479.11 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $4,466.84 / $6,456.54
| Facility | | $1,905.46 | $4,466.84 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,819.70 / $2,398.83
| Professional | | $1,479.11 | $1,819.70 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,715.35 / $7,413.10
| Facility | | $1,096.48 | $3,715.35 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,862.09 / $2,454.71
| Professional | | $1,023.29 | $1,862.09 | $2,454.71 |