- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,360.58 / $2,360.58 / $2,360.58
| Facility | | $2,360.58 | $2,360.58 | $2,360.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,864.73 / $2,360.58 / $2,449.23
| Professional | | $1,864.73 | $2,360.58 | $2,449.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,820.55 / $4,550.16 / $11,396.72
| Facility | | $1,820.55 | $4,550.16 | $11,396.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $633.00 / $830.05 / $3,532.81
| Professional | | $633.00 | $830.05 | $3,532.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.59 / $7,814.37 / $15,826.73
| Facility | | $1,965.59 | $7,814.37 | $15,826.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.55 / $582.88 / $1,016.05
| Professional | | $427.55 | $582.88 | $1,016.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $647.35 / $1,012.70 / $4,499.43
| Facility | | $647.35 | $1,012.70 | $4,499.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,203.92 / $2,203.92 / $10,014.64
| Professional | | $2,203.92 | $2,203.92 | $10,014.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $38.81 / $57.09
| Professional | | $32.34 | $38.81 | $57.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,316.61 / $2,337.61 / $2,861.66
| Facility | | $2,316.61 | $2,337.61 | $2,861.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.26 / $1,597.69 / $4,127.91
| Professional | | $515.26 | $1,597.69 | $4,127.91 |