- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,228.50 / $2,790.45 / $5,001.75
| Facility | | $1,228.50 | $2,790.45 | $5,001.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $930.15 / $1,153.91 / $1,491.75
| Professional | | $930.15 | $1,153.91 | $1,491.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.14 / $423.14 / $1,074.78
| Professional | | $423.14 | $423.14 | $1,074.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,106.00 / $3,707.44 / $6,318.44
| Facility | | $2,106.00 | $3,707.44 | $6,318.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.67 / $8,459.10 / $8,459.10
| Professional | | $2,137.67 | $8,459.10 | $8,459.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $2,106.00 / $3,948.75
| Facility | | $294.00 | $2,106.00 | $3,948.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,842.75 / $2,299.05 / $3,808.35
| Professional | | $1,842.75 | $2,299.05 | $3,808.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,491.75 / $1,755.00 / $3,182.33
| Professional | | $1,491.75 | $1,755.00 | $3,182.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $3,707.44 / $6,318.44
| Facility | | $597.00 | $3,707.44 | $6,318.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,140.75 / $1,895.40 / $4,036.50
| Professional | | $1,140.75 | $1,895.40 | $4,036.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $737.10 / $1,053.00 / $2,659.84
| Professional | | $737.10 | $1,053.00 | $2,659.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,854.80 / $2,018.21 / $2,018.21
| Facility | | $1,854.80 | $2,018.21 | $2,018.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,491.75 / $1,854.80 / $2,116.21
| Professional | | $1,491.75 | $1,854.80 | $2,116.21 |