- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,179.36 / $1,179.36 / $1,191.92
| Facility | | $1,179.36 | $1,179.36 | $1,191.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $966.44 / $1,179.36 / $1,207.54
| Professional | | $966.44 | $1,179.36 | $1,207.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,236.17 / $2,236.17 / $2,374.82
| Facility | | $2,236.17 | $2,236.17 | $2,374.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,242.91 / $1,242.91 / $1,553.76
| Professional | | $1,242.91 | $1,242.91 | $1,553.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,199.00 / $1,199.00 / $1,528.64
| Professional | | $1,199.00 | $1,199.00 | $1,528.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,367.82 / $1,367.82 / $1,367.82
| Facility | | $1,367.82 | $1,367.82 | $1,367.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $998.51 / $998.51 / $1,367.82
| Professional | | $998.51 | $998.51 | $1,367.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,565.33 / $2,012.56 / $2,683.42
| Professional | | $1,565.33 | $2,012.56 | $2,683.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $658.29 / $1,375.30 / $2,509.04
| Facility | | $658.29 | $1,375.30 | $2,509.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,149.00 / $2,937.23 / $3,724.75
| Professional | | $1,149.00 | $2,937.23 | $3,724.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,225.14 / $1,680.51 / $2,668.83
| Facility | | $1,225.14 | $1,680.51 | $2,668.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,225.14 / $1,680.51 / $2,668.83
| Professional | | $1,225.14 | $1,680.51 | $2,668.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $769.93 / $1,347.44 / $1,536.34
| Facility | | $769.93 | $1,347.44 | $1,536.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,008.31 / $1,115.59 / $1,600.49
| Professional | | $1,008.31 | $1,115.59 | $1,600.49 |