- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.30 / $2,007.08 / $6,186.74
| Facility | | $1,513.30 | $2,007.08 | $6,186.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,645.41 / $1,686.54 / $1,748.25
| Professional | | $1,645.41 | $1,686.54 | $1,748.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,450.14 / $3,670.30 / $7,323.21
| Facility | | $1,450.14 | $3,670.30 | $7,323.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,727.68 / $1,727.68 / $1,727.68
| Professional | | $1,727.68 | $1,727.68 | $1,727.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,456.45 / $1,456.45 / $1,456.45
| Facility | | $1,456.45 | $1,456.45 | $1,456.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,748.25 / $1,748.25 / $1,748.25
| Facility | | $1,748.25 | $1,748.25 | $1,748.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,748.25 / $1,748.25 / $1,748.25
| Professional | | $1,748.25 | $1,748.25 | $1,748.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,606.48 / $5,201.60 / $7,712.85
| Facility | | $2,606.48 | $5,201.60 | $7,712.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,815.69 / $7,815.69 / $9,255.42
| Professional | | $7,815.69 | $7,815.69 | $9,255.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,707.11 / $2,056.76 / $3,670.29
| Facility | | $1,707.11 | $2,056.76 | $3,670.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.15 / $1,737.15 / $1,737.15
| Professional | | $1,737.15 | $1,737.15 | $1,737.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,263.70 / $1,889.04 / $1,983.49
| Professional | | $1,263.70 | $1,889.04 | $1,983.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,707.11 / $2,056.76 / $2,794.11
| Facility | | $1,707.11 | $2,056.76 | $2,794.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,748.25 / $1,748.25 / $1,748.25
| Professional | | $1,748.25 | $1,748.25 | $1,748.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,713.97 / $1,713.97 / $1,736.25
| Professional | | $1,713.97 | $1,713.97 | $1,736.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,713.97 / $1,953.92 / $2,637.79
| Professional | | $1,713.97 | $1,953.92 | $2,637.79 |