- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $864.29 / $2,635.07 / $3,140.86
| Facility | | $864.29 | $2,635.07 | $3,140.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.74 / $864.29 / $1,022.80
| Professional | | $530.74 | $864.29 | $1,022.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,748.01 / $1,748.01 / $1,856.39
| Facility | | $1,748.01 | $1,748.01 | $1,856.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $968.81 / $968.81 / $1,244.79
| Professional | | $968.81 | $968.81 | $1,244.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $918.37 / $918.37 / $1,194.93
| Professional | | $918.37 | $918.37 | $1,194.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,162.20 / $1,162.20 / $1,433.06
| Facility | | $1,162.20 | $1,162.20 | $1,433.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $848.41 / $848.41 / $1,238.96
| Professional | | $848.41 | $848.41 | $1,238.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,223.60 / $1,573.21 / $2,097.61
| Professional | | $1,223.60 | $1,573.21 | $2,097.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.29 / $1,023.06 / $1,953.10
| Facility | | $515.29 | $1,023.06 | $1,953.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,007.00 / $2,185.01 / $2,911.62
| Professional | | $1,007.00 | $2,185.01 | $2,911.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.98 / $1,319.21 / $2,137.42
| Facility | | $875.98 | $1,319.21 | $2,137.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $875.98 / $1,319.21 / $2,137.42
| Professional | | $875.98 | $1,319.21 | $2,137.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.73 / $872.06 / $1,313.63
| Professional | | $724.73 | $872.06 | $1,313.63 |