- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,370.03 / $3,632.65 / $10,112.50
| Facility | | $1,370.03 | $3,632.65 | $10,112.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,162.45 / $1,494.58 / $2,490.96
| Professional | | $1,162.45 | $1,494.58 | $2,490.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,075.80 / $2,075.80 / $2,075.80
| Facility | | $2,075.80 | $2,075.80 | $2,075.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,311.49 / $1,452.38 / $5,204.75
| Facility | | $1,311.49 | $1,452.38 | $5,204.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,075.73 / $2,385.08 / $2,981.34
| Professional | | $2,075.73 | $2,385.08 | $2,981.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,321.28 / $9,860.04 / $9,860.04
| Facility | | $3,321.28 | $9,860.04 | $9,860.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,266.24 / $2,075.80 / $2,490.96
| Facility | | $1,266.24 | $2,075.80 | $2,490.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,868.22 / $2,075.80 / $2,075.80
| Professional | | $1,868.22 | $2,075.80 | $2,075.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,266.24 / $2,075.80 / $2,490.96
| Facility | | $1,266.24 | $2,075.80 | $2,490.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,598.37 / $1,972.01 / $2,189.96
| Professional | | $1,598.37 | $1,972.01 | $2,189.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $871.84 / $871.84 / $1,245.48
| Professional | | $871.84 | $871.84 | $1,245.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.04 / $12.34 / $2,075.80
| Professional | | $12.04 | $12.34 | $2,075.80 |