- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.52 / $1,346.52 / $1,714.86
| Facility | | $1,346.52 | $1,346.52 | $1,714.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,203.08 / $1,667.63 / $2,728.71
| Professional | | $1,203.08 | $1,667.63 | $2,728.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,281.01 / $4,751.20 / $7,942.01
| Facility | | $1,281.01 | $4,751.20 | $7,942.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,281.01 / $2,676.44 / $11,568.56
| Professional | | $1,281.01 | $2,676.44 | $11,568.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,397.54 / $1,795.84 / $3,205.96
| Facility | | $1,397.54 | $1,795.84 | $3,205.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,550.10 / $2,475.48 / $4,399.55
| Professional | | $1,550.10 | $2,475.48 | $4,399.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,909.00 / $8,090.00
| Facility | | $300.00 | $1,909.00 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,816.81 / $2,200.76 / $3,008.42
| Professional | | $1,816.81 | $2,200.76 | $3,008.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,526.54 / $3,237.72 / $4,480.41
| Professional | | $1,526.54 | $3,237.72 | $4,480.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,063.00 / $12,850.00
| Facility | | $55.00 | $5,063.00 | $12,850.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,850.64 / $3,418.66 / $11,568.56
| Professional | | $1,850.64 | $3,418.66 | $11,568.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,097.00 / $10,764.00
| Facility | | $2,324.00 | $5,097.00 | $10,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,770.47 / $2,598.40 / $4,725.74
| Professional | | $1,770.47 | $2,598.40 | $4,725.74 |