- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,454.71 / $5,495.41
| Facility | | $1,621.81 | $2,454.71 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $676.08 / $1,288.25
| Professional | | $426.58 | $676.08 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,162.28 / $6,025.60
| Facility | | $1,288.25 | $3,162.28 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $912.01 / $1,174.90
| Professional | | $724.44 | $912.01 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $707.95 / $1,047.13
| Professional | | $346.74 | $707.95 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $660.69 / $1,862.09
| Facility | | $363.08 | $660.69 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $776.25 / $1,202.26
| Professional | | $478.63 | $776.25 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $5,248.07 / $7,413.10
| Facility | | $3,981.07 | $5,248.07 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $912.01 / $1,258.93
| Professional | | $724.44 | $912.01 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $851.14 / $4,365.16
| Professional | | $537.03 | $851.14 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $5,495.41 / $12,302.69
| Facility | | $1,148.15 | $5,495.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $707.95 / $1,071.52
| Professional | | $478.63 | $707.95 | $1,071.52 |