- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $3,235.94 / $4,786.30
| Facility | | $724.44 | $3,235.94 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $588.84 / $1,096.48
| Professional | | $338.84 | $588.84 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $645.65 / $1,023.29
| Professional | | $457.09 | $645.65 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $2,187.76
| Professional | | $32.36 | $33.11 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $4,570.88 / $10,964.78
| Facility | | $3,890.45 | $4,570.88 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $724.44 / $1,122.02
| Professional | | $457.09 | $724.44 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $691.83 / $1,258.93
| Professional | | $467.74 | $691.83 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $831.76 / $1,258.93
| Professional | | $501.19 | $831.76 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,818.38 / $5,128.61
| Facility | | $1,096.48 | $2,818.38 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $602.56 / $891.25
| Professional | | $371.54 | $602.56 | $891.25 |