- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $998.43 / $998.43 / $1,009.06
| Facility | | $998.43 | $998.43 | $1,009.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $833.25 / $998.43 / $1,131.39
| Professional | | $833.25 | $998.43 | $1,131.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,893.11 / $1,893.11 / $2,010.48
| Facility | | $1,893.11 | $1,893.11 | $2,010.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,076.58 / $1,076.58 / $1,403.10
| Professional | | $1,076.58 | $1,076.58 | $1,403.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,015.00 / $1,015.00 / $1,294.11
| Professional | | $1,015.00 | $1,015.00 | $1,294.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,498.90 / $1,498.90 / $1,498.90
| Facility | | $1,498.90 | $1,498.90 | $1,498.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,094.20 / $1,094.20 / $1,498.90
| Professional | | $1,094.20 | $1,094.20 | $1,498.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,325.18 / $1,703.80 / $2,271.73
| Professional | | $1,325.18 | $1,703.80 | $2,271.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $567.55 / $1,186.83 / $2,154.96
| Facility | | $567.55 | $1,186.83 | $2,154.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,198.00 / $2,486.61 / $3,153.31
| Professional | | $1,198.00 | $2,486.61 | $3,153.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,037.18 / $1,428.71 / $2,259.38
| Facility | | $1,037.18 | $1,428.71 | $2,259.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,037.18 / $1,428.71 / $2,259.38
| Professional | | $1,037.18 | $1,428.71 | $2,259.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $853.61 / $944.45 / $1,354.93
| Professional | | $853.61 | $944.45 | $1,354.93 |