- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $2,818.38 / $5,888.44
| Facility | | $213.80 | $2,818.38 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $213.80 / $436.52
| Professional | | $154.88 | $213.80 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $6,025.60 / $7,762.47
| Facility | | $3,715.35 | $6,025.60 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $245.47 / $380.19
| Professional | | $177.83 | $245.47 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $1,659.59
| Facility | | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $239.88 / $389.05
| Professional | | $154.88 | $239.88 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.82 / $245.47 / $1,445.44
| Professional | | $1.82 | $245.47 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $371.54 / $2,570.40
| Professional | | $234.42 | $371.54 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $245.47 / $407.38
| Professional | | $158.49 | $245.47 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $3,090.30 / $9,120.11
| Facility | | $1,659.59 | $3,090.30 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $213.80 / $346.74
| Professional | | $144.54 | $213.80 | $346.74 |