- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $945.62 / $2,609.64 / $5,836.24
| Facility | | $945.62 | $2,609.64 | $5,836.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $867.29 / $1,040.18 / $1,660.99
| Professional | | $867.29 | $1,040.18 | $1,660.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,133.92 / $2,246.06 / $3,531.72
| Facility | | $1,133.92 | $2,246.06 | $3,531.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.91 / $1,778.88 / $6,040.95
| Professional | | $933.91 | $1,778.88 | $6,040.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,378.90 / $1,657.60 / $2,097.05
| Facility | | $1,378.90 | $1,657.60 | $2,097.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,185.44 / $1,185.44 / $1,185.44
| Professional | | $1,185.44 | $1,185.44 | $1,185.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.87 / $2,485.37 / $4,130.47
| Facility | | $1,350.87 | $2,485.37 | $4,130.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,147.88 / $1,954.24 / $3,174.80
| Professional | | $1,147.88 | $1,954.24 | $3,174.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.60 / $1,909.00 / $6,679.00
| Facility | | $891.60 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.85 / $675.73 / $1,582.59
| Professional | | $89.85 | $675.73 | $1,582.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,193.98 / $2,262.59 / $3,005.25
| Professional | | $1,193.98 | $2,262.59 | $3,005.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,082.13 / $3,045.17 / $9,386.95
| Facility | | $2,082.13 | $3,045.17 | $9,386.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.50 / $352.23 / $1,523.02
| Professional | | $182.50 | $352.23 | $1,523.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,950.57 / $1,950.57 / $5,259.82
| Facility | | $1,950.57 | $1,950.57 | $5,259.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,074.31 / $1,811.85 / $6,040.95
| Professional | | $1,074.31 | $1,811.85 | $6,040.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,009.75 / $1,651.62 / $2,999.90
| Professional | | $1,009.75 | $1,651.62 | $2,999.90 |