- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,388.44 / $10,471.29
| Facility | | $933.25 | $3,388.44 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $741.31 / $1,548.82
| Professional | | $630.96 | $741.31 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $912.01 / $1,445.44
| Professional | | $537.03 | $912.01 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $1,479.11
| Professional | | $32.36 | $33.11 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,148.15 / $1,479.11
| Professional | | $891.25 | $1,148.15 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,318.26 / $1,737.80
| Professional | | $660.69 | $1,318.26 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,071.52 / $1,479.11
| Professional | | $831.76 | $1,071.52 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,128.61 / $13,803.84
| Facility | | $2,290.87 | $5,128.61 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $758.58 / $1,202.26
| Professional | | $602.56 | $758.58 | $1,202.26 |