- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,648.48 / $1,660.08 / $2,462.44
| Facility | | $1,648.48 | $1,660.08 | $2,462.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,387.13 / $1,847.43 / $2,523.32
| Professional | | $1,387.13 | $1,847.43 | $2,523.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.06 / $179.06 / $179.06
| Professional | | $179.06 | $179.06 | $179.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,115.00 / $3,115.00 / $3,115.00
| Facility | | $3,115.00 | $3,115.00 | $3,115.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,950.00 / $1,950.00 / $2,601.66
| Facility | | $1,950.00 | $1,950.00 | $2,601.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,657.50 / $1,950.00 / $1,950.00
| Professional | | $1,657.50 | $1,950.00 | $1,950.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,051.47 / $17,045.09 / $17,666.53
| Facility | | $6,051.47 | $17,045.09 | $17,666.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.50 / $1,660.08 / $2,838.62
| Facility | | $311.50 | $1,660.08 | $2,838.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.58 / $923.28 / $2,860.77
| Professional | | $286.58 | $923.28 | $2,860.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.50 / $1,660.08 / $2,696.69
| Facility | | $311.50 | $1,660.08 | $2,696.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.82 / $1,950.00 / $1,950.00
| Professional | | $244.82 | $1,950.00 | $1,950.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,044.44 / $1,253.32 / $2,412.83
| Professional | | $1,044.44 | $1,253.32 | $2,412.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,505.20 / $1,505.20 / $1,688.42
| Professional | | $1,505.20 | $1,505.20 | $1,688.42 |