- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $3,235.94 / $8,912.51
| Facility | | $562.34 | $3,235.94 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $562.34 / $1,148.15
| Professional | | $436.52 | $562.34 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $346.74 / $416.87
| Facility | | $34.67 | $346.74 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $630.96 / $1,071.52
| Professional | | $436.52 | $630.96 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $5,888.44 / $11,481.54
| Facility | | $3,235.94 | $5,888.44 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $489.78 / $812.83
| Professional | | $446.68 | $489.78 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $524.81 / $933.25
| Professional | | $32.36 | $524.81 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,548.13 / $6,760.83
| Facility | | $1,023.29 | $3,548.13 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $575.44 / $1,047.13
| Professional | | $407.38 | $575.44 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $407.38 / $489.78
| Professional | | $407.38 | $407.38 | $489.78 |