- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.94 / $1,026.48 / $2,903.89
| Professional | | $531.94 | $1,026.48 | $2,903.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $1,448.83
| Facility | | $55.00 | $55.00 | $1,448.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,314.51 / $2,523.65 / $6,143.45
| Professional | | $1,314.51 | $2,523.65 | $6,143.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $215.51 / $280.16 / $549.54
| Facility | | $215.51 | $280.16 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.14 / $955.74 / $1,715.46
| Professional | | $302.14 | $955.74 | $1,715.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.33 / $294.72 / $6,679.00
| Facility | | $186.33 | $294.72 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $962.84 / $1,137.55 / $2,033.87
| Professional | | $962.84 | $1,137.55 | $2,033.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.39 / $303.39 / $304.14
| Professional | | $303.39 | $303.39 | $304.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $1,448.83
| Facility | | $55.00 | $55.00 | $1,448.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,314.51 / $2,332.38 / $6,143.45
| Professional | | $1,314.51 | $2,332.38 | $6,143.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,233.40 / $1,978.46 / $3,626.90
| Professional | | $1,233.40 | $1,978.46 | $3,626.90 |