- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.92 / $1,071.92 / $1,083.33
| Facility | | $1,071.92 | $1,071.92 | $1,083.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $989.90 / $1,071.92 / $1,117.55
| Professional | | $989.90 | $1,071.92 | $1,117.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,032.46 / $2,032.46 / $2,158.46
| Facility | | $2,032.46 | $2,032.46 | $2,158.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,702.59 / $1,702.59 / $2,093.50
| Professional | | $1,702.59 | $1,702.59 | $2,093.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,252.48 / $1,252.48 / $1,252.48
| Professional | | $1,252.48 | $1,252.48 | $1,252.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,162.68 / $1,162.68 / $1,162.68
| Facility | | $1,162.68 | $1,162.68 | $1,162.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $988.28 / $988.28 / $1,162.68
| Professional | | $988.28 | $988.28 | $1,162.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,422.72 / $1,829.21 / $2,438.94
| Professional | | $1,422.72 | $1,829.21 | $2,438.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.29 / $1,224.16 / $2,313.60
| Facility | | $599.29 | $1,224.16 | $2,313.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.43 / $2,669.64 / $3,385.41
| Professional | | $35.43 | $2,669.64 | $3,385.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,113.53 / $1,562.50 / $2,596.60
| Facility | | $1,113.53 | $1,562.50 | $2,596.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,113.53 / $1,562.50 / $2,596.60
| Professional | | $1,113.53 | $1,562.50 | $2,596.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $675.98 / $1,013.97 / $1,454.68
| Professional | | $675.98 | $1,013.97 | $1,454.68 |