- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,531.67 / $2,009.33 / $3,743.04
| Facility | | $1,531.67 | $2,009.33 | $3,743.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $285.86 / $371.55
| Professional | | $60.00 | $285.86 | $371.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.75 / $1,754.83 / $3,188.59
| Facility | | $540.75 | $1,754.83 | $3,188.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,769.95 / $2,374.32 / $5,952.08
| Facility | | $1,769.95 | $2,374.32 | $5,952.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.00 / $50.00 / $75.00
| Professional | | $45.00 | $50.00 | $75.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $494.31 / $664.16 / $664.16
| Facility | | $494.31 | $664.16 | $664.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,517.68 / $1,971.67 / $3,701.02
| Facility | | $1,517.68 | $1,971.67 | $3,701.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $388.92 / $1,033.02 / $1,033.02
| Professional | | $388.92 | $1,033.02 | $1,033.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.36 / $354.36 / $354.36
| Professional | | $354.36 | $354.36 | $354.36 |