- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,443.64 / $1,443.64 / $1,759.05
| Facility | | $1,443.64 | $1,443.64 | $1,759.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,290.88 / $1,759.05 / $2,795.48
| Professional | | $1,290.88 | $1,759.05 | $2,795.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,369.61 / $4,751.20 / $10,667.33
| Facility | | $1,369.61 | $4,751.20 | $10,667.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,369.61 / $2,836.62 / $11,734.30
| Professional | | $1,369.61 | $2,836.62 | $11,734.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,493.88 / $1,919.64 / $3,426.96
| Facility | | $1,493.88 | $1,919.64 | $3,426.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,616.59 / $2,625.76 / $4,551.13
| Professional | | $1,616.59 | $2,625.76 | $4,551.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,026.59 / $8,090.00
| Facility | | $300.00 | $2,026.59 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,829.44 / $2,216.05 / $3,015.81
| Professional | | $1,829.44 | $2,216.05 | $3,015.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,637.38 / $3,393.12 / $4,588.60
| Professional | | $1,637.38 | $3,393.12 | $4,588.60 |
- 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
- $1,977.62 / $3,444.11 / $11,734.30
| Professional | | $1,977.62 | $3,444.11 | $11,734.30 |
- 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
- $1,895.07 / $2,818.14 / $4,690.16
| Professional | | $1,895.07 | $2,818.14 | $4,690.16 |