- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,778.28 / $1,778.28
| Facility | | $912.01 | $1,778.28 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $954.99 / $1,819.70
| Professional | | $588.84 | $954.99 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,691.53 / $3,630.78
| Facility | | $2,238.72 | $2,691.53 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,071.52 / $2,818.38
| Professional | | $741.31 | $1,071.52 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,479.11 / $3,162.28
| Facility | | $1,174.90 | $1,479.11 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,467.37 / $6,918.31
| Facility | | $1,288.25 | $3,467.37 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,548.82 / $8,511.38
| Facility | | $912.01 | $1,548.82 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,348.96 / $1,995.26
| Professional | | $1,096.48 | $1,348.96 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,479.11 / $2,691.53
| Professional | | $831.76 | $1,479.11 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,691.53 / $3,630.78
| Facility | | $2,238.72 | $2,691.53 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,071.52 / $2,818.38
| Professional | | $741.31 | $1,071.52 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $2,754.23 / $4,677.35
| Facility | | $870.96 | $2,754.23 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,122.02 / $2,630.27
| Professional | | $831.76 | $1,122.02 | $2,630.27 |