- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $838.44 / $1,106.27 / $1,319.53
| Facility | | $838.44 | $1,106.27 | $1,319.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $886.27 / $1,131.01 / $1,485.00
| Professional | | $886.27 | $1,131.01 | $1,485.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $974.03 / $1,349.14 / $1,915.18
| Professional | | $974.03 | $1,349.14 | $1,915.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,088.77 / $1,167.33 / $1,211.79
| Facility | | $1,088.77 | $1,167.33 | $1,211.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,336.88 / $1,336.88 / $1,336.88
| Facility | | $1,336.88 | $1,336.88 | $1,336.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $962.39 / $1,262.83 / $2,041.97
| Professional | | $962.39 | $1,262.83 | $2,041.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,699.48 / $5,237.81 / $5,661.86
| Facility | | $2,699.48 | $5,237.81 | $5,661.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,372.15 / $8,114.99 / $9,396.15
| Professional | | $7,372.15 | $8,114.99 | $9,396.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $974.43 / $1,204.40 / $1,977.02
| Facility | | $974.43 | $1,204.40 | $1,977.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,231.10 / $1,622.83 / $2,081.69
| Professional | | $1,231.10 | $1,622.83 | $2,081.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,103.32 / $1,414.41 / $2,238.66
| Professional | | $1,103.32 | $1,414.41 | $2,238.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $979.71 / $1,208.99 / $2,082.59
| Facility | | $979.71 | $1,208.99 | $2,082.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $981.64 / $1,386.25 / $2,859.98
| Professional | | $981.64 | $1,386.25 | $2,859.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $767.98 / $1,007.98 / $1,597.98
| Professional | | $767.98 | $1,007.98 | $1,597.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $728.23 / $1,121.92 / $1,539.45
| Professional | | $728.23 | $1,121.92 | $1,539.45 |