- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,383.99 / $1,682.00 / $3,248.00
| Facility | | $1,383.99 | $1,682.00 | $3,248.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.00 / $600.00 / $1,682.00
| Professional | | $306.00 | $600.00 | $1,682.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,885.00 / $1,963.17 / $3,370.38
| Facility | | $1,885.00 | $1,963.17 | $3,370.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,017.19 / $1,279.42 / $2,081.36
| Professional | | $1,017.19 | $1,279.42 | $2,081.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,160.00 / $2,546.84 / $3,051.95
| Professional | | $1,160.00 | $2,546.84 | $3,051.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.00 / $1,218.00 / $2,552.00
| Facility | | $870.00 | $1,218.00 | $2,552.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,160.00 / $1,160.00 / $1,566.00
| Professional | | $1,160.00 | $1,160.00 | $1,566.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,160.00 / $1,218.00 / $2,560.69
| Facility | | $1,160.00 | $1,218.00 | $2,560.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,218.00 / $1,467.40 / $2,818.68
| Facility | | $1,218.00 | $1,467.40 | $2,818.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $935.06 / $1,276.00 / $1,670.40
| Professional | | $935.06 | $1,276.00 | $1,670.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,262.00 / $3,529.88 / $4,554.04
| Facility | | $2,262.00 | $3,529.88 | $4,554.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,048.67 / $2,281.04 / $3,648.23
| Professional | | $2,048.67 | $2,281.04 | $3,648.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.20 / $487.20 / $1,218.00
| Professional | | $487.20 | $487.20 | $1,218.00 |