- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,630.78 / $5,623.41
| Facility | | $2,691.53 | $3,630.78 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $3,235.94 / $3,235.94
| Professional | | $512.86 | $3,235.94 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.03 / $851.14 / $3,548.13
| Facility | | $0.03 | $851.14 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $602.56 / $5,754.40
| Professional | | $446.68 | $602.56 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $676.08 / $741.31
| Facility | | $50.12 | $676.08 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $3,630.78 / $9,772.37
| Facility | | $83.18 | $3,630.78 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,949.84 / $7,079.46
| Facility | | $346.74 | $1,949.84 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.03 / $851.14 / $3,548.13
| Facility | | $0.03 | $851.14 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $602.56 / $5,754.40
| Professional | | $446.68 | $602.56 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,949.84 / $5,623.41
| Facility | | $537.03 | $1,949.84 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $53.70 / $162.18
| Professional | | $48.98 | $53.70 | $162.18 |