- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $980.82 / $1,000.05 / $1,019.29
| Facility | | $980.82 | $1,000.05 | $1,019.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $942.36 / $1,019.29 / $1,819.70
| Professional | | $942.36 | $1,019.29 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,559.39 / $1,559.39 / $1,559.39
| Professional | | $1,559.39 | $1,559.39 | $1,559.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,456.92 / $5,821.21 / $8,577.84
| Facility | | $5,456.92 | $5,821.21 | $8,577.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,045.25 / $1,045.25 / $1,307.76
| Professional | | $1,045.25 | $1,045.25 | $1,307.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,196.33 / $2,196.33 / $2,196.33
| Facility | | $2,196.33 | $2,196.33 | $2,196.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,306.07 / $1,306.07 / $1,306.07
| Facility | | $1,306.07 | $1,306.07 | $1,306.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $953.43 / $953.43 / $1,306.07
| Professional | | $953.43 | $953.43 | $1,306.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,140.65 / $11,870.73 / $11,870.73
| Facility | | $11,140.65 | $11,870.73 | $11,870.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,377.22 / $13,377.22 / $20,901.90
| Professional | | $13,377.22 | $13,377.22 | $20,901.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $673.20 / $1,530.63 / $2,196.33
| Facility | | $673.20 | $1,530.63 | $2,196.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.20 / $1,976.70 / $2,696.46
| Professional | | $673.20 | $1,976.70 | $2,696.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $673.20 / $1,467.53 / $2,196.33
| Facility | | $673.20 | $1,467.53 | $2,196.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $953.43 / $953.43 / $1,392.34
| Professional | | $953.43 | $953.43 | $1,392.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $868.98 / $1,256.63 / $1,495.99
| Professional | | $868.98 | $1,256.63 | $1,495.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,252.24 / $1,258.95 / $2,196.33
| Professional | | $1,252.24 | $1,258.95 | $2,196.33 |