- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,983.33 / $3,819.75 / $6,855.97
| Facility | | $1,983.33 | $3,819.75 | $6,855.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,334.47 / $1,909.88 / $3,011.73
| Professional | | $1,334.47 | $1,909.88 | $3,011.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,448.56 / $2,448.56 / $6,366.26
| Facility | | $2,448.56 | $2,448.56 | $6,366.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $979.42 / $979.42 / $5,697.31
| Professional | | $979.42 | $979.42 | $5,697.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,469.14 / $2,448.56 / $2,448.56
| Facility | | $1,469.14 | $2,448.56 | $2,448.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,787.45 / $2,448.56 / $2,448.56
| Professional | | $1,787.45 | $2,448.56 | $2,448.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,938.27 / $5,172.57 / $6,353.63
| Facility | | $2,938.27 | $5,172.57 | $6,353.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,519.80 / $3,281.14 / $7,905.36
| Professional | | $1,519.80 | $3,281.14 | $7,905.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $332.00 / $2,448.56 / $5,509.26
| Facility | | $332.00 | $2,448.56 | $5,509.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,713.99 / $2,554.58 / $4,480.85
| Professional | | $1,713.99 | $2,554.58 | $4,480.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,081.28 / $2,448.56 / $4,439.96
| Professional | | $2,081.28 | $2,448.56 | $4,439.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $254.50 / $5,973.93 / $6,353.63
| Facility | | $254.50 | $5,973.93 | $6,353.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,523.64 / $3,152.52 / $7,345.68
| Professional | | $1,523.64 | $3,152.52 | $7,345.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,028.40 / $1,469.14 / $3,710.99
| Professional | | $1,028.40 | $1,469.14 | $3,710.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,595.48 / $2,595.48 / $3,411.48
| Facility | | $2,595.48 | $2,595.48 | $3,411.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,081.28 / $2,539.06 / $3,514.04
| Professional | | $2,081.28 | $2,539.06 | $3,514.04 |