- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,019.23 / $1,229.48 / $1,229.48
| Facility | | $1,019.23 | $1,229.48 | $1,229.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,019.23 / $1,229.48 / $1,700.72
| Professional | | $1,019.23 | $1,229.48 | $1,700.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,467.50 / $1,467.50 / $1,467.50
| Professional | | $1,467.50 | $1,467.50 | $1,467.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,716.70 / $1,716.70 / $1,716.70
| Professional | | $1,716.70 | $1,716.70 | $1,716.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,293.24 / $1,293.24 / $1,682.47
| Facility | | $1,293.24 | $1,293.24 | $1,682.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.65 / $1,491.30 / $1,491.30
| Professional | | $160.65 | $1,491.30 | $1,491.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,568.50 / $1,899.04 / $2,555.07
| Professional | | $1,568.50 | $1,899.04 | $2,555.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.40 / $1,066.57 / $1,603.32
| Facility | | $204.40 | $1,066.57 | $1,603.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,927.92 / $1,927.92 / $1,927.92
| Professional | | $1,927.92 | $1,927.92 | $1,927.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.08 / $778.45 / $2,602.10
| Facility | | $143.08 | $778.45 | $2,602.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.08 / $947.25 / $2,602.10
| Professional | | $143.08 | $947.25 | $2,602.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.36 / $890.87 / $1,570.80
| Facility | | $117.36 | $890.87 | $1,570.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $935.31 / $1,111.79 / $1,696.68
| Professional | | $935.31 | $1,111.79 | $1,696.68 |