- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $4,570.88 / $8,511.38
| Facility | | $1,445.44 | $4,570.88 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $812.83 / $1,445.44
| Professional | | $346.74 | $812.83 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $1,174.90 / $1,445.44
| Professional | | $457.09 | $1,174.90 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $588.84 / $4,265.80
| Professional | | $32.36 | $588.84 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $5,623.41 / $12,589.25
| Facility | | $4,786.30 | $5,623.41 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $1,174.90 / $4,168.69
| Professional | | $478.63 | $1,174.90 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $891.25 / $2,630.27
| Professional | | $380.19 | $891.25 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $1,148.15 / $1,819.70
| Professional | | $457.09 | $1,148.15 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,128.61 / $11,481.54
| Facility | | $2,137.96 | $5,128.61 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $724.44 / $1,479.11
| Professional | | $346.74 | $724.44 | $1,479.11 |