- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $2,137.96 / $4,073.80
| Facility | | $467.74 | $2,137.96 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $190.55 / $316.23
| Professional | | $123.03 | $190.55 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,884.03 / $3,981.07
| Facility | | $1,548.82 | $2,884.03 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $208.93 / $354.81
| Professional | | $138.04 | $208.93 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $190.55 / $338.84
| Professional | | $125.89 | $190.55 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $6,918.31 / $19,498.45
| Facility | | $6,918.31 | $6,918.31 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,621.81 / $1,621.81
| Professional | | $1,412.54 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,290.87 / $4,073.80
| Facility | | $1,202.26 | $2,290.87 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $181.97 / $309.03
| Professional | | $123.03 | $181.97 | $309.03 |