- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,884.03 / $5,888.44
| Facility | | $1,148.15 | $2,884.03 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $630.96 / $1,258.93
| Professional | | $562.34 | $630.96 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $6,025.60 / $7,762.47
| Facility | | $3,715.35 | $6,025.60 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $870.96 / $1,148.15
| Professional | | $645.65 | $870.96 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $1,659.59
| Facility | | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $870.96 / $1,202.26
| Professional | | $575.44 | $870.96 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.95 / $724.44 / $2,041.74
| Professional | | $2.95 | $724.44 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $870.96 / $2,570.40
| Professional | | $870.96 | $870.96 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $1,148.15
| Professional | | $575.44 | $575.44 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,344.23 / $7,244.36
| Facility | | $1,288.25 | $2,344.23 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $758.58 / $1,122.02
| Professional | | $537.03 | $758.58 | $1,122.02 |