- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $2,187.76 / $8,511.38
| Facility | | $169.82 | $2,187.76 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $363.08 / $2,344.23
| Professional | | $75.86 | $363.08 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $89.13 / $831.76
| Professional | | $89.13 | $89.13 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,162.28 / $6,165.95
| Facility | | $2,398.83 | $3,162.28 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $181.97 / $707.95
| Professional | | $79.43 | $181.97 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $354.81 / $1,202.26
| Professional | | $91.20 | $354.81 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.72 / $562.34 / $1,348.96
| Facility | | $97.72 | $562.34 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $933.25 / $1,445.44
| Professional | | $575.44 | $933.25 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $812.83 / $1,258.93
| Professional | | $199.53 | $812.83 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $177.83 / $812.83
| Professional | | $177.83 | $177.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $812.83 / $1,096.48
| Professional | | $645.65 | $812.83 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,548.82 / $4,570.88
| Facility | | $1,096.48 | $1,548.82 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $575.44 / $1,071.52
| Professional | | $114.82 | $575.44 | $1,071.52 |