- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,059.70 / $2,415.31 / $4,253.37
| Facility | | $1,059.70 | $2,415.31 | $4,253.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $805.10 / $998.78 / $1,291.20
| Professional | | $805.10 | $998.78 | $1,291.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.16 / $239.16 / $3,463.46
| Professional | | $239.16 | $239.16 | $3,463.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $987.39 / $2,132.76 / $5,306.13
| Facility | | $987.39 | $2,132.76 | $5,306.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,850.06 / $7,321.87 / $7,321.87
| Professional | | $1,850.06 | $7,321.87 | $7,321.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $1,822.87 / $3,417.89
| Facility | | $319.00 | $1,822.87 | $3,417.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,595.01 / $2,005.16 / $3,296.36
| Professional | | $1,595.01 | $2,005.16 | $3,296.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,291.20 / $1,500.28 / $2,754.50
| Professional | | $1,291.20 | $1,500.28 | $2,754.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $2,132.76 / $5,468.37
| Facility | | $597.00 | $2,132.76 | $5,468.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $987.39 / $1,655.78 / $3,493.84
| Professional | | $987.39 | $1,655.78 | $3,493.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.01 / $911.44 / $2,302.26
| Professional | | $638.01 | $911.44 | $2,302.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,519.06 / $1,746.88 / $1,746.88
| Facility | | $1,519.06 | $1,746.88 | $1,746.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,291.20 / $1,519.06 / $1,825.78
| Professional | | $1,291.20 | $1,519.06 | $1,825.78 |