- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,019.88 / $1,019.88 / $1,030.75
| Facility | | $1,019.88 | $1,019.88 | $1,030.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $914.38 / $1,019.88 / $1,104.36
| Professional | | $914.38 | $1,019.88 | $1,104.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,933.80 / $1,933.80 / $2,053.69
| Facility | | $1,933.80 | $1,933.80 | $2,053.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,168.71 / $1,168.71 / $1,510.47
| Professional | | $1,168.71 | $1,168.71 | $1,510.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,037.00 / $1,037.00 / $1,321.94
| Professional | | $1,037.00 | $1,037.00 | $1,321.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,033.69 / $1,226.77 / $1,226.77
| Facility | | $1,033.69 | $1,226.77 | $1,226.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $895.54 / $895.54 / $1,226.77
| Professional | | $895.54 | $895.54 | $1,226.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,353.66 / $1,740.42 / $2,320.56
| Professional | | $1,353.66 | $1,740.42 | $2,320.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $622.83 / $1,226.58 / $2,201.29
| Facility | | $622.83 | $1,226.58 | $2,201.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,087.00 / $2,540.06 / $3,221.09
| Professional | | $1,087.00 | $2,540.06 | $3,221.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,059.47 / $1,453.26 / $2,307.94
| Facility | | $1,059.47 | $1,453.26 | $2,307.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,059.47 / $1,453.26 / $2,307.94
| Professional | | $1,059.47 | $1,453.26 | $2,307.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $899.12 / $964.75 / $1,486.65
| Professional | | $899.12 | $964.75 | $1,486.65 |