- 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
- $575.44 / $630.96 / $1,258.93
| Professional | | $575.44 | $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 / $776.25 / $1,230.27
| Professional | | $645.65 | $776.25 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $4,677.35 / $4,677.35
| Facility | | $4,677.35 | $4,677.35 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $831.76 / $1,174.90
| Professional | | $575.44 | $831.76 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.94 / $724.44 / $6,309.57
| Professional | | $7.94 | $724.44 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $7,762.47
| Professional | | $891.25 | $891.25 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $1,148.15
| Professional | | $588.84 | $588.84 | $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
- $562.34 / $741.31 / $1,096.48
| Professional | | $562.34 | $741.31 | $1,096.48 |