- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $2,884.03 / $5,495.41
| Facility | | $288.40 | $2,884.03 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $630.96 / $1,288.25
| Professional | | $181.97 | $630.96 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $1,548.82 / $4,265.80
| Facility | | $489.78 | $1,548.82 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $1,174.90 / $1,445.44
| Professional | | $331.13 | $1,174.90 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $363.08 / $1,659.59
| Professional | | $218.78 | $363.08 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $1,258.93 / $4,466.84
| Facility | | $281.84 | $1,258.93 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $630.96 / $1,445.44
| Professional | | $208.93 | $630.96 | $1,445.44 |
- 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
- $2,754.23 / $3,630.78 / $5,248.07
| Facility | | $2,754.23 | $3,630.78 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $346.74 / $1,288.25
| Professional | | $245.47 | $346.74 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $660.69 / $3,890.45
| Professional | | $316.23 | $660.69 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $6,165.95 / $7,762.47
| Facility | | $3,467.37 | $6,165.95 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $758.58 / $1,659.59
| Professional | | $204.17 | $758.58 | $1,659.59 |