- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,481.26 / $1,547.45 / $1,716.86
| Facility | | $1,481.26 | $1,547.45 | $1,716.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.34 / $945.29 / $2,834.23
| Professional | | $446.34 | $945.29 | $2,834.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,561.32 / $1,561.32 / $1,561.32
| Facility | | $1,561.32 | $1,561.32 | $1,561.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,141.97 / $1,534.99 / $2,117.96
| Professional | | $1,141.97 | $1,534.99 | $2,117.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,371.95 / $1,592.55 / $1,858.33
| Professional | | $1,371.95 | $1,592.55 | $1,858.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $865.95 / $1,371.94 / $2,388.62
| Facility | | $865.95 | $1,371.94 | $2,388.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $958.00 / $1,183.23 / $2,100.33
| Professional | | $958.00 | $1,183.23 | $2,100.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $952.47 / $1,333.81 / $1,865.95
| Facility | | $952.47 | $1,333.81 | $1,865.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.69 / $401.69 / $677.46
| Professional | | $401.69 | $401.69 | $677.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,234.42 / $1,759.82 / $2,388.62
| Facility | | $1,234.42 | $1,759.82 | $2,388.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,176.69 / $1,653.77 / $2,157.94
| Professional | | $1,176.69 | $1,653.77 | $2,157.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.75 / $1,853.66 / $2,232.77
| Facility | | $1,518.75 | $1,853.66 | $2,232.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,301.58 / $1,685.31 / $1,957.54
| Professional | | $1,301.58 | $1,685.31 | $1,957.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.21 / $1,295.84 / $2,267.34
| Professional | | $870.21 | $1,295.84 | $2,267.34 |