- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $2,454.71 / $5,011.87
| Facility | | $588.84 | $2,454.71 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $575.44 / $1,148.15
| Professional | | $346.74 | $575.44 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $8,128.31 / $8,128.31
| Facility | | $4,570.88 | $8,128.31 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $501.19 / $831.76
| Professional | | $363.08 | $501.19 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,090.30 / $3,090.30
| Facility | | $3,090.30 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $602.56 / $1,071.52
| Professional | | $338.84 | $602.56 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.39 / $660.69 / $2,691.53
| Professional | | $3.39 | $660.69 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $933.25 / $4,786.30
| Professional | | $489.78 | $933.25 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $630.96 / $1,122.02
| Professional | | $331.13 | $630.96 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,548.13 / $10,715.19
| Facility | | $2,290.87 | $3,548.13 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $616.60 / $1,047.13
| Professional | | $346.74 | $616.60 | $1,047.13 |