- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,410.41 / $1,410.41 / $2,433.04
| Facility | | $1,410.41 | $1,410.41 | $2,433.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $840.17 / $1,410.41 / $1,410.41
| Professional | | $840.17 | $1,410.41 | $1,410.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,291.39 / $1,549.67 / $2,942.47
| Facility | | $1,291.39 | $1,549.67 | $2,942.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $918.11 / $1,208.04 / $1,208.04
| Professional | | $918.11 | $1,208.04 | $1,208.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $996.35 / $1,006.48 / $1,006.48
| Facility | | $996.35 | $1,006.48 | $1,006.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $734.73 / $797.08 / $1,867.50
| Professional | | $734.73 | $797.08 | $1,867.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $518.77 / $1,410.41 / $1,833.53
| Facility | | $518.77 | $1,410.41 | $1,833.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $906.00 / $906.00 / $1,095.19
| Professional | | $906.00 | $906.00 | $1,095.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,539.19 / $2,539.19 / $3,904.20
| Professional | | $2,539.19 | $2,539.19 | $3,904.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $820.00 / $820.00 / $820.00
| Facility | | $820.00 | $820.00 | $820.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $617.39 / $803.57 / $1,210.47
| Professional | | $617.39 | $803.57 | $1,210.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,174.02 / $8,733.07 / $8,733.07
| Facility | | $3,174.02 | $8,733.07 | $8,733.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,156.85 / $10,156.85 / $15,870.08
| Professional | | $10,156.85 | $10,156.85 | $15,870.08 |