- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,212.67 / $1,212.67 / $1,383.46
| Facility | | $1,212.67 | $1,212.67 | $1,383.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,020.86 / $1,210.02 / $1,481.07
| Professional | | $1,020.86 | $1,210.02 | $1,481.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,270.25 / $2,110.58 / $4,008.77
| Facility | | $1,270.25 | $2,110.58 | $4,008.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.08 / $1,832.88 / $7,248.35
| Professional | | $707.08 | $1,832.88 | $7,248.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,319.90 / $1,605.79 / $2,011.23
| Facility | | $1,319.90 | $1,605.79 | $2,011.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,506.28 / $1,794.81 / $2,485.37
| Facility | | $1,506.28 | $1,794.81 | $2,485.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,301.92 / $2,180.39 / $3,749.06
| Professional | | $1,301.92 | $2,180.39 | $3,749.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.77 / $1,909.00 / $8,090.00
| Facility | | $1,154.77 | $1,909.00 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $711.68 / $1,276.47 / $2,090.71
| Professional | | $711.68 | $1,276.47 | $2,090.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,451.21 / $2,745.83 / $3,614.38
| Professional | | $1,451.21 | $2,745.83 | $3,614.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,455.17 / $2,455.17 / $6,135.96
| Facility | | $2,455.17 | $2,455.17 | $6,135.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,057.56 / $1,832.88 / $7,248.35
| Professional | | $1,057.56 | $1,832.88 | $7,248.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,054.89 / $1,660.38 / $3,284.88
| Professional | | $1,054.89 | $1,660.38 | $3,284.88 |