- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,387.23 / $1,579.73 / $1,579.73
| Facility | | $1,387.23 | $1,579.73 | $1,579.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $789.91 / $1,011.93 / $1,593.97
| Professional | | $789.91 | $1,011.93 | $1,593.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,329.56 / $1,329.56 / $2,064.41
| Facility | | $1,329.56 | $1,329.56 | $2,064.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,763.80 / $2,186.63 / $2,733.28
| Professional | | $1,763.80 | $2,186.63 | $2,733.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,730.16 / $1,886.02 / $2,076.90
| Professional | | $1,730.16 | $1,886.02 | $2,076.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,196.83 / $2,411.52 / $8,782.71
| Facility | | $1,196.83 | $2,411.52 | $8,782.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $897.20 / $1,198.83 / $2,564.17
| Professional | | $897.20 | $1,198.83 | $2,564.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,058.37 / $2,064.41 / $2,559.54
| Facility | | $2,058.37 | $2,064.41 | $2,559.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,690.78 / $2,411.52 / $3,945.06
| Professional | | $1,690.78 | $2,411.52 | $3,945.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $840.55 / $971.45 / $2,451.83
| Professional | | $840.55 | $971.45 | $2,451.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,839.21 / $1,839.21 / $1,839.21
| Facility | | $1,839.21 | $1,839.21 | $1,839.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,452.98 / $1,839.21 / $1,839.21
| Professional | | $1,452.98 | $1,839.21 | $1,839.21 |