- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,060.52 / $1,060.52 / $3,511.00
| Facility | | $1,060.52 | $1,060.52 | $3,511.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $926.50 / $1,060.52 / $1,123.55
| Professional | | $926.50 | $1,060.52 | $1,123.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,240.82 / $2,465.85 / $3,082.31
| Professional | | $2,240.82 | $2,465.85 | $3,082.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,132.26 / $1,565.79 / $2,877.58
| Facility | | $1,132.26 | $1,565.79 | $2,877.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,027.44 / $2,251.21 / $9,514.93
| Professional | | $1,027.44 | $2,251.21 | $9,514.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.54 / $2,164.08 / $2,721.19
| Facility | | $1,659.54 | $2,164.08 | $2,721.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,251.00 / $2,164.08 / $3,006.25
| Professional | | $1,251.00 | $2,164.08 | $3,006.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $858.16 / $858.16 / $1,115.60
| Professional | | $858.16 | $858.16 | $1,115.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $2,000.00 / $2,000.00
| Facility | | $2,000.00 | $2,000.00 | $2,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,179.21 / $1,977.26 / $3,075.74
| Professional | | $1,179.21 | $1,977.26 | $3,075.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,270.50 / $1,494.70 / $1,554.50
| Professional | | $1,270.50 | $1,494.70 | $1,554.50 |