- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $5,888.44 / $13,182.57
| Facility | | $1,230.27 | $5,888.44 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,047.13 / $1,548.82
| Professional | | $776.25 | $1,047.13 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,884.03 / $3,388.44
| Facility | | $1,348.96 | $2,884.03 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,318.26 / $2,089.30
| Facility | | $1,047.13 | $1,318.26 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,318.26 / $2,238.72
| Professional | | $1,047.13 | $1,318.26 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,445.44 / $2,290.87
| Facility | | $1,174.90 | $1,445.44 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,290.87 / $3,890.45
| Facility | | $1,318.26 | $2,290.87 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,174.90 / $1,548.82
| Professional | | $1,174.90 | $1,174.90 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,949.84 / $3,630.78
| Facility | | $1,380.38 | $1,949.84 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,174.90 / $1,445.44
| Professional | | $1,122.02 | $1,174.90 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,548.82 / $1,548.82
| Facility | | $1,318.26 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $549.54 / $1,445.44
| Professional | | $549.54 | $549.54 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $1,318.26 / $2,344.23
| Professional | | $588.84 | $1,318.26 | $2,344.23 |