- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,259.71 / $1,442.53 / $2,750.96
| Facility | | $1,259.71 | $1,442.53 | $2,750.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,323.35 / $1,389.51 / $1,665.92
| Professional | | $1,323.35 | $1,389.51 | $1,665.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,592.39 / $2,247.01 / $3,987.47
| Facility | | $1,592.39 | $2,247.01 | $3,987.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,282.48 / $1,415.75 / $1,602.84
| Professional | | $1,282.48 | $1,415.75 | $1,602.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,248.44 / $1,323.35 / $1,671.02
| Facility | | $1,248.44 | $1,323.35 | $1,671.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,323.35 / $1,323.35 / $1,687.20
| Professional | | $1,323.35 | $1,323.35 | $1,687.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $1,323.35 / $2,004.86
| Facility | | $580.00 | $1,323.35 | $2,004.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $971.49 / $1,825.09 / $2,239.37
| Professional | | $971.49 | $1,825.09 | $2,239.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,117.35 / $2,176.10 / $2,656.00
| Professional | | $2,117.35 | $2,176.10 | $2,656.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,323.35 / $1,402.75 / $1,593.68
| Professional | | $1,323.35 | $1,402.75 | $1,593.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.30 / $2,131.66 / $7,015.85
| Facility | | $1,760.30 | $2,131.66 | $7,015.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,148.12 / $6,148.12 / $6,148.12
| Professional | | $6,148.12 | $6,148.12 | $6,148.12 |