- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,007.20 / $2,286.34 / $2,387.06
| Facility | | $1,007.20 | $2,286.34 | $2,387.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $804.30 / $1,007.20 / $2,387.06
| Professional | | $804.30 | $1,007.20 | $2,387.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,357.14 / $2,951.46 / $7,396.37
| Facility | | $1,357.14 | $2,951.46 | $7,396.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,103.99 / $1,356.35 / $8,010.83
| Professional | | $1,103.99 | $1,356.35 | $8,010.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,111.22 / $1,111.22 / $1,111.22
| Facility | | $1,111.22 | $1,111.22 | $1,111.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $811.19 / $811.19 / $1,111.22
| Professional | | $811.19 | $811.19 | $1,111.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.76 / $1,608.25 / $4,247.07
| Facility | | $941.76 | $1,608.25 | $4,247.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $995.10 / $1,634.53 / $3,011.27
| Professional | | $995.10 | $1,634.53 | $3,011.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,069.34 / $1,188.16 / $1,306.97
| Professional | | $1,069.34 | $1,188.16 | $1,306.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,394.91 / $1,549.90 / $1,704.89
| Facility | | $1,394.91 | $1,549.90 | $1,704.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,231.25 / $1,231.25 / $1,231.25
| Professional | | $1,231.25 | $1,231.25 | $1,231.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,357.14 / $1,740.61 / $3,027.14
| Facility | | $1,357.14 | $1,740.61 | $3,027.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,475.21 / $1,513.57 / $1,513.57
| Facility | | $1,475.21 | $1,513.57 | $1,513.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,231.25 / $1,317.42 / $1,704.89
| Professional | | $1,231.25 | $1,317.42 | $1,704.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.89 / $1,061.83 / $1,350.55
| Professional | | $707.89 | $1,061.83 | $1,350.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.08 / $1,317.42 / $1,317.42
| Professional | | $954.08 | $1,317.42 | $1,317.42 |